Provider Demographics
NPI:1336228857
Name:SAHEB, SHAIK M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAIK
Middle Name:M
Last Name:SAHEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAIK
Other - Middle Name:M
Other - Last Name:SAHEB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:23504 LYONS AVE
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2500
Mailing Address - Country:US
Mailing Address - Phone:661-259-8010
Mailing Address - Fax:661-259-8793
Practice Address - Street 1:23504 LYONS AVE
Practice Address - Street 2:SUITE 101B
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2500
Practice Address - Country:US
Practice Address - Phone:661-259-8010
Practice Address - Fax:661-259-8793
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37148174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA37148AMedicare ID - Type UnspecifiedNEWHALL MEDICARE ID#
CAWA37148BMedicare ID - Type UnspecifiedNORTHRIDGE MEDICARE ID#