Healthcare Provider Details

I. General information

NPI: 1982148375
Provider Name (Legal Business Name): SHAMARIE SAIS, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 04/24/2017
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 TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD2006-0142
License Number StateNM

VIII. Authorized Official

Name: SHAMARIE SAIS
Title or Position: MANAGER/OWNER
Credential:
Phone: 505-298-0301