Provider Demographics
NPI:1093992141
Name:SHAHEED, RASHAD (BA FAODP)
Entity Type:Individual
Prefix:
First Name:RASHAD
Middle Name:
Last Name:SHAHEED
Suffix:
Gender:M
Credentials:BA FAODP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12501 HAMILTON AVE
Mailing Address - Street 2:2168 CHENE ST.
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3243
Mailing Address - Country:US
Mailing Address - Phone:313-320-4736
Mailing Address - Fax:313-865-1582
Practice Address - Street 1:12501 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3243
Practice Address - Country:US
Practice Address - Phone:313-320-3647
Practice Address - Fax:313-865-1582
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1093992141Medicaid
MI1093992141OtherTAXONAMY
MIOP23520Medicare PIN