Provider Demographics
NPI:1669003760
Name:SHAKOURI, MARYAM (NP)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:SHAKOURI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8181 FANNIN ST APT 1637
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2924
Mailing Address - Country:US
Mailing Address - Phone:719-947-2014
Mailing Address - Fax:
Practice Address - Street 1:2801 GESSNER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-2503
Practice Address - Country:US
Practice Address - Phone:719-947-2014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily