Basic Information
| Provider Information | |||||||||
| NPI: | 1306928817 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEWANI | ||||||||
| FirstName: | SHABANA | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 810 JASONWAY AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432144359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144423130 | ||||||||
| FaxNumber: | 6144423145 | ||||||||
| Practice Location | |||||||||
| Address1: | 810 JASONWAY AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432144359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144423130 | ||||||||
| FaxNumber: | 6144423145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 06/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OHIO TRAINING CERTIF | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RX0202X | 35093809 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0087900 | 05 | OH | MEDICAID |