Provider Demographics
NPI:1659504173
Name:SHAHEEN, MICHAEL KELLY (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KELLY
Last Name:SHAHEEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 HILLS AND DALES RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-1507
Mailing Address - Country:US
Mailing Address - Phone:330-478-8996
Mailing Address - Fax:330-478-9987
Practice Address - Street 1:4555 HILLS AND DALES RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-1507
Practice Address - Country:US
Practice Address - Phone:330-478-8996
Practice Address - Fax:330-478-9987
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5894152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist