Provider Demographics
NPI:1497746416
Name:SHAMMAA, SHARIF S (PA-C)
Entity Type:Individual
Prefix:
First Name:SHARIF
Middle Name:S
Last Name:SHAMMAA
Suffix:
Gender:M
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 1:623 TEMPLE ST
Mailing Address - Street 2:POB 370
Mailing Address - City:HINTON
Mailing Address - State:WV
Mailing Address - Zip Code:25951-2230
Mailing Address - Country:US
Mailing Address - Phone:304-466-1243
Mailing Address - Fax:
Practice Address - Street 1:115 SUMMERS HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:WV
Practice Address - Zip Code:25951
Practice Address - Country:US
Practice Address - Phone:304-466-2918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV647363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000628Medicaid