Healthcare Provider Details

I. General information

NPI: 1811263411
Provider Name (Legal Business Name): OMAR SHAYAN AHMED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 OMNI BLVD STE 111
NEWPORT NEWS VA
23606-4430
US

IV. Provider business mailing address

860 OMNI BLVD STE 111
NEWPORT NEWS VA
23606
US

V. Phone/Fax

Practice location:
  • Phone: 757-369-8138
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR4091
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101259674
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number0101259674
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101259674
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: