Provider Demographics
NPI:1619317419
Name:SHAMIM, SANA JAHAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:SANA
Middle Name:JAHAN
Last Name:SHAMIM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4384
Mailing Address - Country:US
Mailing Address - Phone:301-696-0818
Mailing Address - Fax:
Practice Address - Street 1:63 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE C
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4384
Practice Address - Country:US
Practice Address - Phone:301-696-0818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01600213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist