Provider Demographics
NPI:1740735653
Name:SHAMSI, SHAMIM (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAMIM
Middle Name:
Last Name:SHAMSI
Suffix:
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 1:1762 DEERBROOK TRL
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6666
Mailing Address - Country:US
Mailing Address - Phone:937-426-4529
Mailing Address - Fax:937-426-4529
Practice Address - Street 1:1762 DEERBROOK TRL
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-6666
Practice Address - Country:US
Practice Address - Phone:937-426-4529
Practice Address - Fax:937-426-4529
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35032707207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology