Provider Demographics
NPI:1952072555
Name:AKTHER, SHAJEEN UDDIN (MSPAS)
Entity Type:Individual
Prefix:
First Name:SHAJEEN
Middle Name:UDDIN
Last Name:AKTHER
Suffix:
Gender:F
Credentials:MSPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 TAVERN RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2845
Mailing Address - Country:US
Mailing Address - Phone:304-350-8733
Mailing Address - Fax:
Practice Address - Street 1:1000 TAVERN RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2845
Practice Address - Country:US
Practice Address - Phone:304-350-8733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD363A00000X
MDC0008220363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant