Provider Demographics
NPI:1285616383
Name:SHETH, SANJAY Y (MD)
Entity type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:Y
Last Name:SHETH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 ROBBINS AVEVNUE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-2468
Mailing Address - Country:US
Mailing Address - Phone:330-652-7973
Mailing Address - Fax:330-652-7876
Practice Address - Street 1:940 ROBBINS AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-2468
Practice Address - Country:US
Practice Address - Phone:330-652-7973
Practice Address - Fax:330-652-7876
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35085218207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311513392031OtherCARESOURCE
OH000000480108OtherANTHEM
OH2715708Medicaid
OH000000248094OtherUNISON
OH450294OtherWELLCARE
OH7745806OtherAETNA
OH7745806OtherAETNA
OH2715708Medicaid
OH7745806OtherAETNA
OH450294OtherWELLCARE
OH2715708Medicaid