Provider Demographics
NPI:1972169266
Name:ALAM, SHEULI (PA)
Entity Type:Individual
Prefix:
First Name:SHEULI
Middle Name:
Last Name:ALAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 E MCDERMOTT DR STE A
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-2802
Mailing Address - Country:US
Mailing Address - Phone:469-646-6200
Mailing Address - Fax:
Practice Address - Street 1:60 E MCDERMOTT DR STE A
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-2802
Practice Address - Country:US
Practice Address - Phone:469-646-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11029363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical