Healthcare Provider Details

I. General information

NPI: 1235625922
Provider Name (Legal Business Name): MARIA SHOAIB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE STE 460
VANCOUVER WA
98664-1965
US

IV. Provider business mailing address

920 STANTON L YOUNG BLVD # WP2040
OKLAHOMA CITY OK
73104-5036
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-7771
  • Fax: 360-514-7769
Mailing address:
  • Phone: 405-271-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number33774
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD61376398
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: