Provider Demographics
NPI:1164273405
Name:SHAHSAMAND, ALI YOUSEF (DO)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:YOUSEF
Last Name:SHAHSAMAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 BROWN CIR
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5239
Mailing Address - Country:US
Mailing Address - Phone:201-575-9305
Mailing Address - Fax:
Practice Address - Street 1:4225 W 20TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5835
Practice Address - Country:US
Practice Address - Phone:786-828-7552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program