Selena Shamo
Physician Assistant in Detroit, MI. Individual provider (NPI-1).
NPI number1124844014
StatusActive
Last updated in NPPESJun 18, 2025
Details
- NPI
- 1124844014
- Entity type
- Individual (NPI-1)
- Name
- Ms. Selena Shamo
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Nov 25, 2024
- Certification date
- Jun 18, 2025
- Last updated
- Jun 18, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 1235097 | MI | Yes |
Practice location
259 Mack Ave Ste 2590Detroit, MI 48201-2427
Phone 313-577-1716
Mailing address
259 Mack Ave Ste 2590Detroit, MI 48201-2427
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