Provider Demographics
NPI:1760239214
Name:CORE PSYCH EAST
Entity type:Organization
Organization Name:CORE PSYCH EAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHADY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEBAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-961-6420
Mailing Address - Street 1:3815 PELHAM ST STE 13
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3852
Mailing Address - Country:US
Mailing Address - Phone:586-961-6420
Mailing Address - Fax:586-204-0211
Practice Address - Street 1:28 1ST ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2523
Practice Address - Country:US
Practice Address - Phone:586-961-6420
Practice Address - Fax:586-204-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty