Provider Demographics
NPI:1013973064
Name:CHAMBERLAND, SHIREEN NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:SHIREEN
Middle Name:NICOLE
Last Name:CHAMBERLAND
Suffix:
Gender:F
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:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:541-734-3430
Mailing Address - Fax:541-734-3638
Practice Address - Street 1:965 ELLENDALE DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8215
Practice Address - Country:US
Practice Address - Phone:541-734-3430
Practice Address - Fax:541-734-3638
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26786207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR278437Medicaid
ORR183483Medicare PIN
OR278437Medicaid