Provider Demographics
NPI:1619367372
Name:SHAHEER, TAMARA
Entity Type:Individual
Prefix:MISS
First Name:TAMARA
Middle Name:
Last Name:SHAHEER
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 1:3998 WOODBERRY MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2497
Mailing Address - Country:US
Mailing Address - Phone:571-274-4200
Mailing Address - Fax:
Practice Address - Street 1:13047 FAIR LAKES CENTER
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2497
Practice Address - Country:US
Practice Address - Phone:571-274-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230025595183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician