Healthcare Provider Details

I. General information

NPI: 1346514783
Provider Name (Legal Business Name): SHELINA M JAMAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE DEPT OF CARDIAC ICU
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

1545 NW MARKET ST APT 416
SEATTLE WA
98107-5250
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2140
  • Fax:
Mailing address:
  • Phone: 617-733-6729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD 60108231
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMD 60108231
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: