Provider Demographics
NPI:1073218814
Name:SHAMAI, EVELYNE
Entity Type:Individual
Prefix:
First Name:EVELYNE
Middle Name:
Last Name:SHAMAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 MERCER PKWY APT 4102
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-1439
Mailing Address - Country:US
Mailing Address - Phone:214-883-9612
Mailing Address - Fax:
Practice Address - Street 1:1790 MERCER PKWY APT 4102
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-1439
Practice Address - Country:US
Practice Address - Phone:469-806-9342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45949231343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)