MEDICARE: DR. TABASSUM SHAMIM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	ME115364	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538185616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TABASSUM SHAMIM MD

Provider Business Mailing Address
First Line	:	PO BOX 42116
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3709 W HAMILTON AVE
Second Line	:	SUITE # 4
City	:	TAMPA
State	:	FL
Zip	:	33614-4015
Country	:	US
Telephone Number	:	813-515-7988
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	03/31/2020

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Directions to “ DR. TABASSUM SHAMIM MD” Practice Location

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