Provider Demographics
NPI:1124213160
Name:KAMBI-SHAMBA, DUMISANI (MSTOM)
Entity Type:Individual
Prefix:
First Name:DUMISANI
Middle Name:
Last Name:KAMBI-SHAMBA
Suffix:
Gender:M
Credentials:MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 E. 33RD ST.
Mailing Address - Street 2:SUITE 604
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5336
Mailing Address - Country:US
Mailing Address - Phone:212-447-0750
Mailing Address - Fax:212-447-0751
Practice Address - Street 1:45 E 33RD ST
Practice Address - Street 2:SUITE 604
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5336
Practice Address - Country:US
Practice Address - Phone:212-447-0750
Practice Address - Fax:212-447-0751
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003586171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist