Provider Demographics
NPI:1417576380
Name:SHANMUGAM, SHAMILA (PA-C)
Entity Type:Individual
Prefix:
First Name:SHAMILA
Middle Name:
Last Name:SHANMUGAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2285 CORPORATE CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7759
Mailing Address - Country:US
Mailing Address - Phone:702-360-2763
Mailing Address - Fax:949-783-2880
Practice Address - Street 1:1242 E MCKELLIPS RD STE 103
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2764
Practice Address - Country:US
Practice Address - Phone:480-962-4269
Practice Address - Fax:480-962-3702
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant