Provider Demographics
NPI:1235352287
Name:SHAH, SHAILEE C
Entity Type:Individual
Prefix:
First Name:SHAILEE
Middle Name:C
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6279 MOONSTONE DR
Mailing Address - Street 2:
Mailing Address - City:GRANDBLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439
Mailing Address - Country:US
Mailing Address - Phone:810-953-9032
Mailing Address - Fax:
Practice Address - Street 1:6026 LAPEER RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-2215
Practice Address - Country:US
Practice Address - Phone:810-742-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist