Provider Demographics
NPI:1235231747
Name:SHAMO, STEVEN W (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:W
Last Name:SHAMO
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 1:140 WHITE SAGE AVE
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:UT
Mailing Address - Zip Code:84624-8928
Mailing Address - Country:US
Mailing Address - Phone:435-864-3333
Mailing Address - Fax:435-864-2790
Practice Address - Street 1:140 WHITE SAGE AVE
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:UT
Practice Address - Zip Code:84624-8928
Practice Address - Country:US
Practice Address - Phone:435-864-3333
Practice Address - Fax:435-864-2790
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT263400-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTF86797Medicare UPIN
UT000011542Medicare ID - Type Unspecified