Provider Demographics
NPI:1316904980
Name:DOUMANI-SEMINO, SHELLEY JACQUELYN (MD)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:JACQUELYN
Last Name:DOUMANI-SEMINO
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 1:11638 N 12TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-1221
Mailing Address - Country:US
Mailing Address - Phone:602-799-9111
Mailing Address - Fax:602-293-3236
Practice Address - Street 1:11638 N 12TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-1221
Practice Address - Country:US
Practice Address - Phone:602-799-9111
Practice Address - Fax:602-293-3236
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ246482084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG44896Medicare UPIN
AZ21905Medicare ID - Type Unspecified