Provider Demographics
NPI:1578274676
Name:DHALIWAL, SHAMEER (PA)
Entity Type:Individual
Prefix:
First Name:SHAMEER
Middle Name:
Last Name:DHALIWAL
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 1:4900 LONG PRAIRIE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2288
Mailing Address - Country:US
Mailing Address - Phone:972-948-1802
Mailing Address - Fax:
Practice Address - Street 1:4900 LONG PRAIRIE RD STE 100
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2288
Practice Address - Country:US
Practice Address - Phone:972-948-1802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16302363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical