Provider Demographics
NPI:1548421035
Name:SHAMOON, ULFAT JABEEN
Entity Type:Individual
Prefix:
First Name:ULFAT
Middle Name:JABEEN
Last Name:SHAMOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41034 MARKS DR # 2
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-4932
Mailing Address - Country:US
Mailing Address - Phone:248-348-7188
Mailing Address - Fax:248-348-7188
Practice Address - Street 1:41034 MARKS DR # 2
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-4932
Practice Address - Country:US
Practice Address - Phone:249-348-7188
Practice Address - Fax:248-348-7188
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator