Healthcare Provider Details

I. General information

NPI: 1437435591
Provider Name (Legal Business Name): SHEHI MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100A SOUTHBRIDGE PKWY
BIRMINGHAM AL
35209-1370
US

IV. Provider business mailing address

2100A SOUTHBRIDGE PKWY
BIRMINGHAM AL
35209-1370
US

V. Phone/Fax

Practice location:
  • Phone: 205-871-9898
  • Fax:
Mailing address:
  • Phone: 205-871-9898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9215
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number9215
License Number StateAL

VIII. Authorized Official

Name: DR. LYLE E SHEHI JR.
Title or Position: PHYSICIAN
Credential: M. D.
Phone: 205-871-9898