Provider Demographics
NPI:1316939937
Name:SHAH, DIPIKA JAYESH (MD)
Entity type:Individual
Prefix:
First Name:DIPIKA
Middle Name:JAYESH
Last Name:SHAH
Suffix:
Gender:F
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:PO BOX 637735
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7735
Mailing Address - Country:US
Mailing Address - Phone:513-891-1006
Mailing Address - Fax:513-793-1032
Practice Address - Street 1:102 TE MAR WAY
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-8530
Practice Address - Country:US
Practice Address - Phone:937-393-5067
Practice Address - Fax:937-393-5652
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350813052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2355437Medicaid
OH2118046OtherCIGNA
OH000000255382OtherANTHEM
OHP00022363OtherRAILROAD MEDICARE
H75061Medicare UPIN
OH2355437Medicaid