Healthcare Provider Details

I. General information

NPI: 1003253212
Provider Name (Legal Business Name): CAROLYN SHAMMAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 WASHINGTON AVE STE 220
LEXINGTON KY
40536-0003
US

IV. Provider business mailing address

111 WASHINGTON AVE STE 220
LEXINGTON KY
40536-0003
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-2100
  • Fax:
Mailing address:
  • Phone: 859-218-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberR3618
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number256512
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: