REENE SHALLAL (FNP) – Family Nurse Practitioner, NPI 1356053904

REENE SHALLAL (FNP) is a healthcare provider. based in Walled lake, Michigan. specializing in NURSE PRACTITIONER. They hold the professional credentials FNP. They hold a License No. 4704259539 (MI). The NPI Number for REENE SHALLAL (FNP) is 1356053904

Main info

Female
4 Years Of Experience
Accepts Medicare Assignment
Name
REENE SHALLAL (FNP)
NPI
1356053904
Phone
(248) 624-4555
Address
100 W West Maple Rd
Enumeration Date
14 December 2022
Last Update Date
5 June 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2488640100
Graduation Year
2022 (4 years ago)
PAC ID
7214307362
Group Practice PAC ID
8729475207
Professional Enrollment ID
I20230105002070
Address ID
MI483903907CO39450RDXX500
Telehealth
Yes
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience30
Completeness75
Years active:3State licenses:1Digital endpointsOther names

8,106 NURSE PRACTITIONER in MI

Provider Addresses for REENE SHALLAL (FNP)

  • 100 W West Maple Rd

    Walled Lake, MI 483903402

    Phone: (248) 624-4555

    Type: Location

  • 1 FORD PL STE 3A

    DETROIT, MI 482023450

    Phone: (313) 874-4806

    Type: Mailing

  • 1961 S TELEGRAPH RD

    BLOOMFIELD HILLS, MI 483020246

    Phone: (248) 319-6190

    Fax: (248) 607-6362

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2023-01-05

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20230105002070INurse PractitionerMITBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes4034$0
99203New patient office or other outpatient visit, 30-44 minutes3030$0
90694Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage2828$0
G0008Administration of influenza virus vaccine2828$0
99204New patient office or other outpatient visit, 45-59 minutes1616$0
View full utilization report →

Insurance plans in this area (ZIP 48390)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8729475207View full group profile
NameSpecialtyState
Nurse PractitionerMI
Physician AssistantMI
Nurse PractitionerMI
Family PracticeMI
Physician AssistantMI

Reviews

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Frequently asked questions

Where can patients find REENE SHALLAL (FNP)'s NPI?
You can confirm REENE SHALLAL (FNP) with NPI 1356053904; it appears in the national provider directory.
Is REENE SHALLAL (FNP)'s enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
Does REENE SHALLAL (FNP) list a primary specialty?
If you are matching referrals, note Family Nurse Practitioner for REENE SHALLAL (FNP). Clinical services aligned with this taxonomy classification.
Where is REENE SHALLAL (FNP)'s primary listing?
We display Walled Lake, Michigan because that is what the record indicates for REENE SHALLAL (FNP).
How can I contact REENE SHALLAL (FNP)?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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