Provider Demographics
NPI:1285689976
Name:BAHL, SHALINI (MD)
Entity type:Individual
Prefix:DR
First Name:SHALINI
Middle Name:
Last Name:BAHL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SHALINI
Other - Middle Name:
Other - Last Name:ANNAMRAJU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1029 STAY LIT CT
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-8981
Mailing Address - Country:US
Mailing Address - Phone:937-284-2536
Mailing Address - Fax:
Practice Address - Street 1:8363 YANKEE ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-1809
Practice Address - Country:US
Practice Address - Phone:937-885-4412
Practice Address - Fax:937-977-1705
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073578207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBA4055853Medicare ID - Type Unspecified
OHH42589Medicare UPIN