Provider Demographics
NPI:1336532548
Name:FEDEWA, SHAHEEN AHMAD (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHAHEEN
Middle Name:AHMAD
Last Name:FEDEWA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:SHAHEEN
Other - Middle Name:AHMAD
Other - Last Name:FEDEWA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:213 OBSIDIAN DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-6480
Mailing Address - Country:US
Mailing Address - Phone:571-408-0926
Mailing Address - Fax:
Practice Address - Street 1:3480 WAKE FOREST RD STE 204
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7376
Practice Address - Country:US
Practice Address - Phone:919-862-5291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05638363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical