Healthcare Provider Details

I. General information

NPI: 1346433687
Provider Name (Legal Business Name): SHAMEL HASHEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4930 LINDELL BLVD
SAINT LOUIS MO
63108-1510
US

IV. Provider business mailing address

1600 CALIFORNIA DR
VACAVILLE CA
95687
US

V. Phone/Fax

Practice location:
  • Phone: 314-361-8700
  • Fax:
Mailing address:
  • Phone: 707-448-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2007023394
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2007023394
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: