Healthcare Provider Details

I. General information

NPI: 1639597750
Provider Name (Legal Business Name): SHAMIR HASAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 AMBASSADOR CAFFERY PKWY # 100
LAFAYETTE LA
70508-6984
US

IV. Provider business mailing address

5000 AMBASSADOR CAFFERY PKWY # 100
LAFAYETTE LA
70508-6984
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-4444
  • Fax:
Mailing address:
  • Phone: 337-534-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number322406
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: