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NPI Code Detail

MEDICARE: JESSICA SHAHEEN MD

MEDICARE:   JESSICA  SHAHEEN  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2208600000XSurgery Physician60893MN

General Provider Information

NPI Number : 1518200914
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA SHAHEEN MD
Provider Business Mailing Address
First Line : 303 E NICOLLET BLVD STE 300
Second Line :
City : BURNSVILLE
State : MN
Zip : 55337-4594
Country : US
Telephone Number : 952-435-4140
Fax Number :
Provider Business Practice Location Address
First Line : 303 E NICOLLET BLVD STE 300
Second Line :
City : BURNSVILLE
State : MN
Zip : 55337
Country : US
Telephone Number : 952-435-4140
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2013
Last Update Date : 08/01/2018

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