Individual
DR. SHANELI FERNANDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3000 REGENCY CT, SUITE 207, TOLEDO, OH 43623-3092
(419) 471-0493
(419) 474-0390
Mailing address
3000 REGENCY CT, SUITE 207, TOLEDO, OH 43623-3092
(419) 471-0493
(419) 474-0390
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
091524
OH
2085R0001X
Radiation Oncology Physician
239860
NY
2085R0001X
Radiation Oncology Physician
Primary
69611-20
WI
2085R0001X
Radiation Oncology Physician
SF078490
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0N24000018
MI MEDICARE
MI
01
—
1508811654
MI MEDICAID - OH LOCATIONS
MI
05
—
1508811654
—
MI
05
—
2837005
—
OH
01
—
P00630915
RR MEDICARE
MI
01
—
P00630915
RR MEDICARE
OH
Enumeration date
05/24/2006
Last updated
08/06/2018
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