Healthcare Provider Details

I. General information

NPI: 1033094800
Provider Name (Legal Business Name): SHYMAA MOHAMED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2025
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 CANTERBURY RD
GROSSE POINTE WOODS MI
48236-1293
US

IV. Provider business mailing address

1110 CANTERBURY RD
GROSSE POINTE WOODS MI
48236-1293
US

V. Phone/Fax

Practice location:
  • Phone: 269-910-6298
  • Fax:
Mailing address:
  • Phone: 269-910-6298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005957
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: