Provider Demographics
NPI:1972760676
Name:SHAHEEN, JULIE (DPM)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SHAHEEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-0655
Mailing Address - Country:US
Mailing Address - Phone:603-658-0190
Mailing Address - Fax:603-658-0196
Practice Address - Street 1:21 HAMPTON RD
Practice Address - Street 2:BLDG 1
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4831
Practice Address - Country:US
Practice Address - Phone:603-658-0190
Practice Address - Fax:603-658-0196
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0322213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30366659Medicaid
NH000643101Medicare PIN