Provider Demographics
NPI:1285605519
Name:FERNANDES, SHAILA PATEL (MD)
Entity type:Individual
Prefix:
First Name:SHAILA
Middle Name:PATEL
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAILA
Other - Middle Name:SIDDHARTH
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 1188
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-1188
Mailing Address - Country:US
Mailing Address - Phone:419-861-7052
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:5901 MONCLOVA RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1841
Practice Address - Country:US
Practice Address - Phone:419-893-5984
Practice Address - Fax:419-891-8033
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077775207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2037521Medicaid
OH4117261Medicare PIN
OH2037521Medicaid