Provider Demographics
NPI:1952964249
Name:MOORE SHELBY, DIAMOND RASHIDA (MD)
Entity Type:Individual
Prefix:
First Name:DIAMOND
Middle Name:RASHIDA
Last Name:MOORE SHELBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIAMOND
Other - Middle Name:RASHIDA
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:248-849-3447
Mailing Address - Fax:248-849-8120
Practice Address - Street 1:1600 S. CANTON CENTER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188
Practice Address - Country:US
Practice Address - Phone:734-398-7880
Practice Address - Fax:734-761-7318
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
MI4301507301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program