Provider Demographics
NPI:1285728469
Name:MIAN, SHAHEEN (MD)
Entity type:Individual
Prefix:
First Name:SHAHEEN
Middle Name:
Last Name:MIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGHLAND ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186
Mailing Address - Country:US
Mailing Address - Phone:617-696-5118
Mailing Address - Fax:617-696-5117
Practice Address - Street 1:100 HIGHLAND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186
Practice Address - Country:US
Practice Address - Phone:617-696-5118
Practice Address - Fax:617-696-5117
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77276207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA077276OtherTUFTS
MA65033OtherHPHC
MA3147291Medicaid
MA3147291Medicaid
MA65033OtherHPHC