Provider Demographics
NPI:1578929162
Name:MOHAMED, SHAMSO JAMA
Entity Type:Individual
Prefix:
First Name:SHAMSO
Middle Name:JAMA
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4236 LINDELL BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2948
Mailing Address - Country:US
Mailing Address - Phone:314-833-5760
Mailing Address - Fax:314-833-5760
Practice Address - Street 1:4236 LINDELL BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2948
Practice Address - Country:US
Practice Address - Phone:314-833-5760
Practice Address - Fax:314-833-5762
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide