Provider Demographics
NPI:1427059567
Name:PESICK-CAINE, SHELLY DEBBIE (MD)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:DEBBIE
Last Name:PESICK-CAINE
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 1:6775 RIDGECLIFF DR
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-3884
Mailing Address - Country:US
Mailing Address - Phone:440-248-2481
Mailing Address - Fax:
Practice Address - Street 1:6559 WILSON MILLS RD
Practice Address - Street 2:BLDG D SUITE 101
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-6402
Practice Address - Country:US
Practice Address - Phone:440-473-0010
Practice Address - Fax:440-460-2812
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2011-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056188208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000026098OtherUNICARE LIFE AND HEALTH
OH380761OtherWELLCARE
OH000000026098OtherANTHEM BCBS
OH0744921Medicaid
OHR56188OtherSUMMARE HEALTH PLAN