Provider Demographics
NPI:1730613704
Name:SHAMSEDEAN, ZEINAB-DESIREE
Entity type:Individual
Prefix:DR
First Name:ZEINAB-DESIREE
Middle Name:
Last Name:SHAMSEDEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:DESIREE
Other - Middle Name:
Other - Last Name:SHAMSEDEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15240 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2645
Mailing Address - Country:US
Mailing Address - Phone:313-806-3244
Mailing Address - Fax:
Practice Address - Street 1:15240 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2645
Practice Address - Country:US
Practice Address - Phone:313-806-3244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302047696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist