Provider Demographics
NPI:1124459854
Name:SHAHEEN, GABRIELLA M (PAC)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:M
Last Name:SHAHEEN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:GABRIELLA
Other - Middle Name:
Other - Last Name:DOGNILLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:627 BUTTERNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2566 HAYMAKER RD STE 203
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3554
Practice Address - Country:US
Practice Address - Phone:412-858-7088
Practice Address - Fax:412-858-7016
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010005363A00000X
PAMA056566363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031540210001Medicaid
PA1031540210001Medicaid
PA340668PNLMedicare PIN