Healthcare Provider Details

I. General information

NPI: 1730920570
Provider Name (Legal Business Name): AMMARA SHAMSHAD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 09/06/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 KIMBAL AVE, STE 101 MERCY ONE NORTHEAST IOWA
WATERLOO IA
50702
US

IV. Provider business mailing address

2055 KIMBAL AVE, STE 101 MERCY ONE NORTHEAST IOWA
WATERLOO IA
50702
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-2529
  • Fax: 319-272-2527
Mailing address:
  • Phone: 319-272-2112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR-13122
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: