Healthcare Provider Details

I. General information

NPI: 1619886132
Provider Name (Legal Business Name): SHAIMA SHEBRAIN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 E G AVE
KALAMAZOO MI
49004-1703
US

IV. Provider business mailing address

3319 HERITAGE PKWY
DEARBORN MI
48124-3189
US

V. Phone/Fax

Practice location:
  • Phone: 269-382-5327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901603157
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: