Provider Demographics
NPI:1053896795
Name:SHABANDARI, SHARIS C (CNP)
Entity type:Individual
Prefix:
First Name:SHARIS
Middle Name:C
Last Name:SHABANDARI
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4975 BRADENTON AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3521
Mailing Address - Country:US
Mailing Address - Phone:614-766-0773
Mailing Address - Fax:614-766-2599
Practice Address - Street 1:4975 BRADENTON AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3521
Practice Address - Country:US
Practice Address - Phone:614-766-0773
Practice Address - Fax:614-766-2599
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRNCNP022758363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPRNCNP022758OtherSTATE LICENSE