Provider Demographics
NPI:1902548910
Name:SCHOTTENSTEIN, NICOLE (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SCHOTTENSTEIN
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 1:8050 E MAIN ST STE 3200
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2819
Mailing Address - Country:US
Mailing Address - Phone:614-434-5437
Mailing Address - Fax:614-434-5438
Practice Address - Street 1:8050 E MAIN ST STE 3200
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2819
Practice Address - Country:US
Practice Address - Phone:614-434-5437
Practice Address - Fax:614-434-5438
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.153897208000000X
OH57.253332208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics