Provider Demographics
NPI:1871542324
Name:JAIN, SHASHI B (MD)
Entity type:Individual
Prefix:DR
First Name:SHASHI
Middle Name:B
Last Name:JAIN
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:PO BOX 385
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-0385
Mailing Address - Country:US
Mailing Address - Phone:800-841-4236
Mailing Address - Fax:706-653-0615
Practice Address - Street 1:630 E RIVER ST
Practice Address - Street 2:4TH FLOOR PATH DEPT
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-5902
Practice Address - Country:US
Practice Address - Phone:440-329-7656
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069279207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2224131Medicaid
OHG21020Medicare UPIN
OHJA4082721Medicare ID - Type UnspecifiedWOOSTER
OHJA4082724Medicare ID - Type UnspecifiedSAMARITAN
OH2224131Medicaid
OHJA4082725Medicare ID - Type UnspecifiedAMHERST