Provider Demographics
NPI:1174307169
Name:SHAHEEN, DEVIN M (NP)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:M
Last Name:SHAHEEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HOLLY HILL LN
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6074
Mailing Address - Country:US
Mailing Address - Phone:203-863-4673
Mailing Address - Fax:
Practice Address - Street 1:55 HOLLY HILL LN
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6074
Practice Address - Country:US
Practice Address - Phone:203-863-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13708363L00000X
MN10665363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner