Healthcare Provider Details

I. General information

NPI: 1245205772
Provider Name (Legal Business Name): SIHAM MUNTASSER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

791 JONESTOWN RD DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL MEDICINE
WINSTON SALEM NC
27103-1252
US

IV. Provider business mailing address

791 JONESTOWN RD
WINSTON SALEM NC
27103-1252
US

V. Phone/Fax

Practice location:
  • Phone: 304-282-2359
  • Fax:
Mailing address:
  • Phone: 304-282-2359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number21382
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2012-02425
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: