Provider Demographics
NPI:1528295524
Name:MODI, SHREYA NALIN (DMD)
Entity type:Individual
Prefix:DR
First Name:SHREYA
Middle Name:NALIN
Last Name:MODI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5455 N MARGINAL RD APT 339
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-3946
Mailing Address - Country:US
Mailing Address - Phone:614-446-0994
Mailing Address - Fax:216-844-3086
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:RB&C SUITE 1200
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3080
Practice Address - Fax:216-844-3086
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH28461223G0001X
OH30-0232981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice