Healthcare Provider Details

I. General information

NPI: 1417764499
Provider Name (Legal Business Name): ALI MOHAMED SHAMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20032
US

IV. Provider business mailing address

3019 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20032
US

V. Phone/Fax

Practice location:
  • Phone: 202-800-4433
  • Fax:
Mailing address:
  • Phone: 202-800-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: