Healthcare Provider Details

I. General information

NPI: 1114997434
Provider Name (Legal Business Name): RAYMOND MICHAEL SHAHEEN I M.D., F.A.C.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 SOUTH DR SUITE 7
MOUNTAIN VIEW CA
94040-4200
US

IV. Provider business mailing address

305 SOUTH DR SUITE 7
MOUNTAIN VIEW CA
94040-4200
US

V. Phone/Fax

Practice location:
  • Phone: 650-965-1909
  • Fax: 650-965-1944
Mailing address:
  • Phone: 650-965-1909
  • Fax: 650-965-1944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA63071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: