Individual
ROSELLEN PROVOST SHAHIDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-2911
(207) 662-6006
Mailing address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-2911
(207) 662-6006
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD30125
ME
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/23/2023
Last updated
05/04/2026
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