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General NPI Number Information
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NPI Number | 1629649355
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Entity Type | Individual
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Provider Name | SHAMAILA KHALIQ
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Gender | Female
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Dates
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Enumeration Date | 07/04/2021
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 1622 HOLLAND RD
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City | SUFFOLK
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State | VA
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Zip | 23434-6767
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Country | US
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Telephone | 757-539-2998
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Fax |
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Provider Business Mailing Address
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Address Line | 1622 HOLLAND RD
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City | SUFFOLK
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State | VA
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Zip | 23434-6767
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Country | US
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Telephone | 757-539-2998
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN122399
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401417807
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License Number State | VA
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