Healthcare Provider Details

I. General information

NPI: 1013364686
Provider Name (Legal Business Name): WAEL ABDULLAH ALSHEHRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST BOX 836
BOSTON MA
02111-1552
US

IV. Provider business mailing address

55 STATION LNDG 407 W
MEDFORD MA
02155-5007
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-1619
  • Fax:
Mailing address:
  • Phone: 520-481-4071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDR.0076903
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: