Provider Demographics
NPI:1932120474
Name:SHAHEEN, JOHN ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:SHAHEEN
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 1:910 MAJOR SHERMAN LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4642
Mailing Address - Country:US
Mailing Address - Phone:831-373-3600
Mailing Address - Fax:831-373-0686
Practice Address - Street 1:910 MAJOR SHERMAN LN
Practice Address - Street 2:SUITE 205
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4642
Practice Address - Country:US
Practice Address - Phone:831-373-3600
Practice Address - Fax:831-373-0686
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG078334208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG783340OtherMEDI-CAL
CA00G783340Medicare ID - Type UnspecifiedMEDICARE NUMBER
CAOOG783340OtherMEDI-CAL