Provider Demographics
NPI:1790883288
Name:ALEMAYEHU, SHIMELLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIMELLIS
Middle Name:
Last Name:ALEMAYEHU
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 1:9841 GREENBELT RD STE 206
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-6270
Mailing Address - Country:US
Mailing Address - Phone:301-552-0008
Mailing Address - Fax:301-552-2066
Practice Address - Street 1:9841 GREENBELT RD STE 206
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-6270
Practice Address - Country:US
Practice Address - Phone:301-552-0008
Practice Address - Fax:301-552-2066
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD405352084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC643148ZEZAOtherMEDICARE PTAN
MD5938813Medicaid
DC643148ZEZAOtherMEDICARE PTAN
DC643148Medicare PIN