Healthcare Provider Details

I. General information

NPI: 1386889293
Provider Name (Legal Business Name): SHAMS SHEIKH, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 VIAGGIO LN
FOOTHILL RANCH CA
92610-1926
US

IV. Provider business mailing address

3 VIAGGIO LN
FOOTHILL RANCH CA
92610-1926
US

V. Phone/Fax

Practice location:
  • Phone: 866-540-6539
  • Fax:
Mailing address:
  • Phone: 866-540-6539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberM5503
License Number StateTX

VIII. Authorized Official

Name: SHAMS SHEIKH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 866-540-6539