Provider Demographics
NPI:1508589664
Name:SHAMSEDDIN, SHADDI VALINO
Entity Type:Individual
Prefix:
First Name:SHADDI
Middle Name:VALINO
Last Name:SHAMSEDDIN
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 1:485 SAWDUST RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2263
Mailing Address - Country:US
Mailing Address - Phone:281-363-9583
Mailing Address - Fax:
Practice Address - Street 1:19710 HOLZWARTH RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-6215
Practice Address - Country:US
Practice Address - Phone:281-350-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist