Provider Demographics
NPI:1528375854
Name:SHAHEEN, SAFAA A (INTERN STUDENT)
Entity Type:Individual
Prefix:
First Name:SAFAA
Middle Name:A
Last Name:SHAHEEN
Suffix:
Gender:F
Credentials:INTERN STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1833
Mailing Address - Country:US
Mailing Address - Phone:617-442-7400
Mailing Address - Fax:617-541-3797
Practice Address - Street 1:435 WARREN ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1833
Practice Address - Country:US
Practice Address - Phone:617-442-7400
Practice Address - Fax:617-541-3797
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program