Healthcare Provider Details

I. General information

NPI: 1356657977
Provider Name (Legal Business Name): SHARIQ SHAMIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5838 HARBOUR VIEW BLVD STE 270
SUFFOLK VA
23435-3602
US

IV. Provider business mailing address

3640 HIGH ST STE 1E
PORTSMOUTH VA
23707-3213
US

V. Phone/Fax

Practice location:
  • Phone: 757-541-1050
  • Fax: 757-541-1097
Mailing address:
  • Phone: 757-399-2639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101287262
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number0101287262
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: