MEDICARE: SHAMATHKHAN SHEIK MOHAIDEEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT137456	TX
2	225200000X	Physical Therapy Assistant	2187598	TX

General Provider Information

NPI Number	:	1083416549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAMATHKHAN SHEIK MOHAIDEEN

Provider Business Mailing Address
First Line	:	1661 PLEASANT VALLEY LN
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75036-8225
Country	:	US
Telephone Number	:	262-309-4122
Fax Number	:

Provider Business Practice Location Address
First Line	:	1661 PLEASANT VALLEY LN
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75036-8225
Country	:	US
Telephone Number	:	262-309-4122
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2025
Last Update Date	:	03/26/2025

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Directions to “ SHAMATHKHAN SHEIK MOHAIDEEN ” Practice Location

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