Provider Demographics
NPI:1740666098
Name:SHAMOON, NARIMAN
Entity type:Individual
Prefix:
First Name:NARIMAN
Middle Name:
Last Name:SHAMOON
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 1:14585 SPARROW DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-5042
Mailing Address - Country:US
Mailing Address - Phone:586-822-7365
Mailing Address - Fax:
Practice Address - Street 1:14585 SPARROW DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-5042
Practice Address - Country:US
Practice Address - Phone:586-822-7365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-09
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0036565561305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service