Healthcare Provider Details

I. General information

NPI: 1942287677
Provider Name (Legal Business Name): SABA ADEL SHAMOON-MICHAUD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 HUTTLESTON AVE
FAIRHAVEN MA
02719-5630
US

IV. Provider business mailing address

10 LEBARON WAY
MATTAPOISETT MA
02739-1210
US

V. Phone/Fax

Practice location:
  • Phone: 508-996-9333
  • Fax: 508-996-3443
Mailing address:
  • Phone: 508-758-4412
  • Fax: 508-996-3443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number159509
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: