Basic Information
| Provider Information | |||||||||
| NPI: | 1609895952 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAHMAN | ||||||||
| FirstName: | SHAKIL | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8614 SHEPHERD FARM DR | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450691128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139429500 | ||||||||
| FaxNumber: | 5139429501 | ||||||||
| Practice Location | |||||||||
| Address1: | 8614 SHEPHERD FARM DR | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450691128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139429500 | ||||||||
| FaxNumber: | 5139429501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 09/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | 35086069 | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 000000363277 | 01 | OH | ANTHEM | OTHER | 2571873 | 05 | OH | MEDICAID |