Provider Demographics
NPI:1669438719
Name:SHAMAA, SHERIF M I (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERIF
Middle Name:M
Last Name:SHAMAA
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 SABLE CREEK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259
Mailing Address - Country:US
Mailing Address - Phone:201-286-4535
Mailing Address - Fax:210-277-0643
Practice Address - Street 1:3322 SABLE CRK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-2219
Practice Address - Country:US
Practice Address - Phone:210-286-4535
Practice Address - Fax:210-286-4535
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044550A207R00000X
MO2018033138207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN110162198OtherRAILROAD MEDICARE
IN000000091336OtherANTHEM BCBS
IN020327300OtherFEDERAL BLACK LUNG
IL200083880AMedicaid
IN278489OtherHARMONY
IL200083880AMedicaid
IN181550AMedicare ID - Type Unspecified