Provider Demographics
NPI:1255080560
Name:SHAHEEN, ANDREW MARTIN
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARTIN
Last Name:SHAHEEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-8404
Mailing Address - Country:US
Mailing Address - Phone:562-565-9344
Mailing Address - Fax:
Practice Address - Street 1:1131 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-8404
Practice Address - Country:US
Practice Address - Phone:562-565-9344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer