Provider Demographics
NPI:1275887150
Name:CLARK, SHAMIRA MALIK (PCT)
Entity Type:Individual
Prefix:MS
First Name:SHAMIRA
Middle Name:MALIK
Last Name:CLARK
Suffix:
Gender:F
Credentials:PCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60423
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31420-0423
Mailing Address - Country:US
Mailing Address - Phone:912-596-4312
Mailing Address - Fax:
Practice Address - Street 1:10714 ABERCORN ST APT 17D
Practice Address - Street 2:APT. 17D
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1426
Practice Address - Country:US
Practice Address - Phone:912-596-4312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant