Provider Demographics
NPI:1447522172
Name:SHAMS, SHARMINEH (MD)
Entity type:Individual
Prefix:
First Name:SHARMINEH
Middle Name:
Last Name:SHAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4617 W MODOC CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-9382
Mailing Address - Country:US
Mailing Address - Phone:310-871-8748
Mailing Address - Fax:
Practice Address - Street 1:5400 W HILLSDALE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5140
Practice Address - Country:US
Practice Address - Phone:559-738-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123837207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA113362OtherSID # 113362