Healthcare Provider Details

I. General information

NPI: 1447148671
Provider Name (Legal Business Name): SHAHEEN NICOLE GANEM PMHNP-BC, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PLEASANT HILL RD
SCARBOROUGH ME
04074-9688
US

IV. Provider business mailing address

202 MAIN ST
SALEM NH
03079-3170
US

V. Phone/Fax

Practice location:
  • Phone: 207-813-7938
  • Fax: 207-656-6243
Mailing address:
  • Phone: 272-268-5794
  • Fax: 207-656-6243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberEL33116
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP251630
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN78942
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: