Provider Demographics
NPI:1265666911
Name:SHAHEEN, TARIK
Entity Type:Individual
Prefix:
First Name:TARIK
Middle Name:
Last Name:SHAHEEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2207
Mailing Address - Country:US
Mailing Address - Phone:512-838-4264
Mailing Address - Fax:512-838-4264
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2088
Practice Address - Country:US
Practice Address - Phone:512-838-4264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012548732084P0800X, 2084P0804X
WAMD608693752084P0800X, 2084P0804X
MN639322084P0800X, 2084P0804X
ORMD1755752084P0800X, 2084P0804X
WI161-3202084P0800X, 2084P0804X
TXQ20612084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry