Provider Demographics
NPI:1316107154
Name:BHATTY, SHAUN MZ (MD)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:MZ
Last Name:BHATTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 BETHESDA DR FL 1
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1873
Mailing Address - Country:US
Mailing Address - Phone:740-454-0804
Mailing Address - Fax:740-454-7171
Practice Address - Street 1:955 BETHESDA DR FL 1
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1873
Practice Address - Country:US
Practice Address - Phone:740-454-0804
Practice Address - Fax:740-454-7171
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249288207R00000X
WV27026207RC0001X
OH35.132005207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0235417Medicaid