Provider Demographics
NPI:1417830498
Name:SHAMASYOSIF, NIAAM
Entity type:Individual
Prefix:
First Name:NIAAM
Middle Name:
Last Name:SHAMASYOSIF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36649 RHEA CT
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4367
Mailing Address - Country:US
Mailing Address - Phone:872-806-9802
Mailing Address - Fax:
Practice Address - Street 1:36649 RHEA CT
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4367
Practice Address - Country:US
Practice Address - Phone:872-806-9802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901602751122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist