Provider Demographics
NPI:1891025060
Name:MUNSHI, NISHAAT FATHIMA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NISHAAT
Middle Name:FATHIMA
Last Name:MUNSHI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NISHAAT
Other - Middle Name:FATHIMA
Other - Last Name:ISMAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12553 GULF FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-4509
Mailing Address - Country:US
Mailing Address - Phone:281-481-8557
Mailing Address - Fax:281-484-7916
Practice Address - Street 1:12553 GULF FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-4509
Practice Address - Country:US
Practice Address - Phone:281-481-8557
Practice Address - Fax:281-484-7916
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009039323363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2009039323OtherMISSOURI PA LICENSE
TXPA06753OtherLICENSE
MO2009039323OtherMISSOURI PA LICENSE
MOMA1140009Medicare PIN