Provider Demographics
NPI:1942494851
Name:NAMASAKA, KHAYANGA SHAKILO (MD)
Entity Type:Individual
Prefix:DR
First Name:KHAYANGA
Middle Name:SHAKILO
Last Name:NAMASAKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 W PERIMETER RD
Mailing Address - Street 2:
Mailing Address - City:ANDREWS AFB
Mailing Address - State:MD
Mailing Address - Zip Code:20762-6601
Mailing Address - Country:US
Mailing Address - Phone:240-857-4896
Mailing Address - Fax:
Practice Address - Street 1:1050 W PERIMETER RD
Practice Address - Street 2:
Practice Address - City:ANDREWS AFB
Practice Address - State:MD
Practice Address - Zip Code:20762-6601
Practice Address - Country:US
Practice Address - Phone:240-857-4896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064318A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice