Provider Demographics
NPI:1275652273
Name:SHEDEED, REDA E (MD)
Entity Type:Individual
Prefix:DR
First Name:REDA
Middle Name:E
Last Name:SHEDEED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 E MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:OH
Mailing Address - Zip Code:43907
Mailing Address - Country:US
Mailing Address - Phone:740-942-8638
Mailing Address - Fax:740-942-9052
Practice Address - Street 1:1200 J D ANDERSON DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3494
Practice Address - Country:US
Practice Address - Phone:304-598-1200
Practice Address - Fax:304-598-1699
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146763207Q00000X
PAMD450866207Q00000X, 208M00000X
NY243034207Q00000X
WVWV-SE-1774207Q00000X, 208M00000X
OH35.133192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02995013Medicaid
OH0283628Medicaid
CA146763OtherFAMILY PRACTICE