Provider Demographics
NPI:1376804955
Name:MOMIN, SHAMEEM (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAMEEM
Middle Name:
Last Name:MOMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 COPPERMILL TRCE APT G
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4739
Mailing Address - Country:US
Mailing Address - Phone:804-869-9969
Mailing Address - Fax:
Practice Address - Street 1:722 E BUTLER PIKE
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-2310
Practice Address - Country:US
Practice Address - Phone:267-663-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4578782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry