Provider Demographics
NPI:1609388347
Name:SHAJI, REMA (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:REMA
Middle Name:
Last Name:SHAJI
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 PARK GROVE DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-4706
Mailing Address - Country:US
Mailing Address - Phone:214-766-6273
Mailing Address - Fax:
Practice Address - Street 1:1506 PARK GROVE DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-4706
Practice Address - Country:US
Practice Address - Phone:214-766-6273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135262363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health