Provider Demographics
NPI:1972502540
Name:MESSIAH, NABIL SHA (PA-C, MBBCH)
Entity Type:Individual
Prefix:DR
First Name:NABIL
Middle Name:SHA
Last Name:MESSIAH
Suffix:
Gender:M
Credentials:PA-C, MBBCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 W 8TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6511
Mailing Address - Country:US
Mailing Address - Phone:904-383-1014
Mailing Address - Fax:904-244-5090
Practice Address - Street 1:LANDSTUHL REGIONAL MEDICAL CENTER
Practice Address - Street 2:CMR402
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:US
Practice Address - Phone:49637-186-8590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105307363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY08C6OtherBCBS
FL005561700Medicaid
FLP01046793OtherRAILROAD MEDICARE ATTACHED TO GRP# DR6927
FLFB924VMedicare PIN
FLFB924YMedicare PIN
FLY08C6OtherBCBS
FLP01046793OtherRAILROAD MEDICARE ATTACHED TO GRP# DR6927