Healthcare Provider Details

I. General information

NPI: 1619831559
Provider Name (Legal Business Name): MUHAMMAD QASIM SHAHID
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5197 NW LOWER RIVER RD
VANCOUVER WA
98660-1013
US

IV. Provider business mailing address

10805 NE 119TH PL
VANCOUVER WA
98662-3429
US

V. Phone/Fax

Practice location:
  • Phone: 360-205-1222
  • Fax:
Mailing address:
  • Phone: 360-726-9892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCAAR.CG.61688766
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: