Provider Demographics
NPI:1699855098
Name:SHAHEEDY, MOHAMAD (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:
Last Name:SHAHEEDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 BALBOA BLVD
Mailing Address - Street 2:#210
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316
Mailing Address - Country:US
Mailing Address - Phone:818-501-7111
Mailing Address - Fax:818-501-7211
Practice Address - Street 1:5400 BALBOA BLVD
Practice Address - Street 2:#210
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316
Practice Address - Country:US
Practice Address - Phone:818-501-7111
Practice Address - Fax:818-501-7211
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39062208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics