Provider Demographics
NPI:1730130824
Name:FAROOQUI, SHAMA PATHAN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:SHAMA
Middle Name:PATHAN
Last Name:FAROOQUI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:SHAMA
Other - Middle Name:PATHAN
Other - Last Name:FAROOQUI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:6308 SEAWALK DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2270
Mailing Address - Country:US
Mailing Address - Phone:919-622-1623
Mailing Address - Fax:
Practice Address - Street 1:4650 SUNSET BLVD.
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-361-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC171982367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8052098Medicare ID - Type Unspecified
NC2607292AMedicare ID - Type Unspecified