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General NPI Number Information
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NPI Number | 1114612611
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Entity Type | Individual
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Provider Name | SEREEN SHAMOUN
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Gender | Female
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 1040 WISHARD BLVD FL 2
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-2872
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Country | US
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Telephone | 317-278-7930
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Fax | 317-962-5479
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Provider Business Mailing Address
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Address Line | 1040 WISHARD BLVD FL 2
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-2872
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Country | US
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Telephone | 317-278-7930
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Fax | 317-962-5479
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 11024036A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 125.082840
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License Number State | IL
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