Provider Demographics
NPI:1790177038
Name:MOHAMMED, SHIRA LYNNE (PA)
Entity Type:Individual
Prefix:MISS
First Name:SHIRA
Middle Name:LYNNE
Last Name:MOHAMMED
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:600 N WOLFE ST
Mailing Address - Street 2:HALSTED 677
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0005
Mailing Address - Country:US
Mailing Address - Phone:410-955-5165
Mailing Address - Fax:410-614-2079
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:HALSTED 677
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-955-5165
Practice Address - Fax:410-614-2079
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical