Provider Demographics
NPI:1922483957
Name:NOOR, SHAMSA
Entity Type:Individual
Prefix:
First Name:SHAMSA
Middle Name:
Last Name:NOOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9306 KITE ST
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3341
Mailing Address - Country:US
Mailing Address - Phone:703-424-7837
Mailing Address - Fax:703-424-7838
Practice Address - Street 1:9306 KITE ST
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-3341
Practice Address - Country:US
Practice Address - Phone:703-424-7837
Practice Address - Fax:703-424-7838
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT25029968172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver