Provider Demographics
NPI:1922078179
Name:SHAMS, MAJID A (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAJID
Middle Name:A
Last Name:SHAMS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15940 PINE STRAND CT
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6365
Mailing Address - Country:US
Mailing Address - Phone:561-753-5997
Mailing Address - Fax:561-795-4897
Practice Address - Street 1:1035 S STATE ROAD 7
Practice Address - Street 2:SUITE 315-11
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6134
Practice Address - Country:US
Practice Address - Phone:561-753-5997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4959103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59444AMedicare PIN
FL59444AMedicare ID - Type Unspecified