Provider Demographics
NPI:1942567862
Name:AZIMI, SHAKILA (FNP)
Entity Type:Individual
Prefix:
First Name:SHAKILA
Middle Name:
Last Name:AZIMI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHAKILA
Other - Middle Name:
Other - Last Name:AMINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:35 MEDICAL CENTER PARKWAY, SUITE 101
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-430-4321
Practice Address - Fax:207-430-4320
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP121005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME002704601Medicare PIN
MEP01081646Medicare PIN
ME002704602Medicare PIN