Provider Demographics
NPI:1467081810
Name:SHEHADEH, RAMZY SAMIR (BA)
Entity Type:Individual
Prefix:
First Name:RAMZY
Middle Name:SAMIR
Last Name:SHEHADEH
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 VERNON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6311
Mailing Address - Country:US
Mailing Address - Phone:916-782-1111
Mailing Address - Fax:916-782-4544
Practice Address - Street 1:1780 VERNON ST STE 1
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6311
Practice Address - Country:US
Practice Address - Phone:916-782-1111
Practice Address - Fax:916-782-4544
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor