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General NPI Number Information
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NPI Number | 1457980062
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Entity Type | Individual
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Provider Name | SHIFA MANSOOR AHMED
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Gender | Female
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Dates
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Enumeration Date | 04/06/2020
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 1890 RESEARCH FOREST DR
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City | SHENANDOAH
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State | TX
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Zip | 77381-4566
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Country | US
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Telephone | 832-658-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 2412 BIRCH ST
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City | DES PLAINES
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State | IL
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Zip | 60018-2228
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Country | US
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Telephone | 312-532-4625
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | U5335
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MT219751
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License Number State | PA
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