=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801865878
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAMARIE SAIS MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2006
-----------------------------------------------------
Last Update Date | 12/08/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3602 CAMPUS BLVD NE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87106-1314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-404-8925
-----------------------------------------------------
Fax | 505-404-8918
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3602 CAMPUS BLVD NE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87106-1314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-404-8925
-----------------------------------------------------
Fax | 505-404-8918
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VF0040X
-----------------------------------------------------
Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
-----------------------------------------------------
License Number | MD2006-0142
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | 43908
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | MD2006-0142
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------