Healthcare Provider Details

I. General information

NPI: 1497746416
Provider Name (Legal Business Name): SHARIF S SHAMMAA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SUMMERS HOSPITAL RD
HINTON WV
25951
US

IV. Provider business mailing address

623 TEMPLE ST POB 370
HINTON WV
25951-2230
US

V. Phone/Fax

Practice location:
  • Phone: 304-466-2918
  • Fax:
Mailing address:
  • Phone: 304-466-1243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number647
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: