Provider Demographics
NPI:1235853797
Name:HAQUE, SHAYLA SHARMIN (PA-C)
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:SHARMIN
Last Name:HAQUE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13179 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20777-9720
Mailing Address - Country:US
Mailing Address - Phone:240-470-7056
Mailing Address - Fax:
Practice Address - Street 1:8665 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3405
Practice Address - Country:US
Practice Address - Phone:301-340-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0008604207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine