Provider Demographics
NPI:1407253727
Name:SAMATAR, SHARMARKE (PA)
Entity Type:Individual
Prefix:
First Name:SHARMARKE
Middle Name:
Last Name:SAMATAR
Suffix:
Gender:M
Credentials:PA
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 14461
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-0461
Mailing Address - Country:US
Mailing Address - Phone:952-994-0559
Mailing Address - Fax:
Practice Address - Street 1:327 CEDAR AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1030
Practice Address - Country:US
Practice Address - Phone:612-294-1333
Practice Address - Fax:612-999-1815
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11726363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical