Provider Demographics
NPI:1962408161
Name:SHAMMA, FAYEK NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:FAYEK
Middle Name:NICHOLAS
Last Name:SHAMMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37000 WOODWARD AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-0944
Mailing Address - Country:US
Mailing Address - Phone:248-952-9600
Mailing Address - Fax:248-844-2538
Practice Address - Street 1:37000 WOODWARD AVE STE 350
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-0944
Practice Address - Country:US
Practice Address - Phone:248-952-9600
Practice Address - Fax:248-844-2538
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFN059015207VE0102X
OH35.065228207VE0102X
OH35065228207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35065228OtherOHIO LICENSE #
IL036410841OtherILLINOIS LICENSE #