Provider Demographics
NPI:1982815643
Name:SHEHADEH, SAMAH M (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMAH
Middle Name:M
Last Name:SHEHADEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SAMAH
Other - Middle Name:M
Other - Last Name:ALI-SHEHADEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:HIMA PLAZA 1 , AVE LUIS MUNOZ MARIN
Mailing Address - Street 2:SUITE #312
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-529-3102
Mailing Address - Fax:
Practice Address - Street 1:AVE LOS ASTROS 1766
Practice Address - Street 2:GOLDEN HILL
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-529-3102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15488207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine