Provider Demographics
NPI:1811287584
Name:SHAH, SAMREEN (MD)
Entity type:Individual
Prefix:DR
First Name:SAMREEN
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SAMREEN
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:26901 BEAUMONT BLVD
Mailing Address - Street 2:STE 3D
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:248-680-8203
Mailing Address - Fax:248-680-8030
Practice Address - Street 1:ASCENSION PROVIDENCE HOSPITAL
Practice Address - Street 2:16001 W NINE MILE ROAD
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-849-3000
Practice Address - Fax:248-338-5564
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010982912084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry