Healthcare Provider Details

I. General information

NPI: 1801865878
Provider Name (Legal Business Name): SHAMARIE SAIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3602 CAMPUS BLVD NE
ALBUQUERQUE NM
87106-1314
US

IV. Provider business mailing address

3602 CAMPUS BLVD NE
ALBUQUERQUE NM
87106-1314
US

V. Phone/Fax

Practice location:
  • Phone: 505-404-8925
  • Fax: 505-404-8918
Mailing address:
  • Phone: 505-404-8925
  • Fax: 505-404-8918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberMD2006-0142
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number43908
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD2006-0142
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: