Provider Demographics
NPI:1154644300
Name:RAO, SHAMA S (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAMA
Middle Name:S
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 EAST 38TH ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1216
Mailing Address - Country:US
Mailing Address - Phone:973-219-3680
Mailing Address - Fax:973-881-8750
Practice Address - Street 1:30 EAST 38TH ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-8750
Practice Address - Country:US
Practice Address - Phone:973-219-3680
Practice Address - Fax:973-881-8750
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02642800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics