Healthcare Provider Details

I. General information

NPI: 1396712915
Provider Name (Legal Business Name): SHAMA SHAKIR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 HOSPITAL DR
BAY ST LOUIS MS
39520-1604
US

IV. Provider business mailing address

PO BOX 475
BILOXI MS
39533
US

V. Phone/Fax

Practice location:
  • Phone: 228-463-9666
  • Fax: 228-463-0712
Mailing address:
  • Phone: 228-374-2494
  • Fax: 228-374-2713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17318
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: