Provider Demographics
NPI:1407457757
Name:SHEHADEH, ALI
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:SHEHADEH
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 1:46983 FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2486
Mailing Address - Country:US
Mailing Address - Phone:734-404-6065
Mailing Address - Fax:734-892-2909
Practice Address - Street 1:46983 FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2486
Practice Address - Country:US
Practice Address - Phone:313-737-3331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy