Provider Demographics
NPI:1023522422
Name:SHAUKATALI, SHAMA (PA-C)
Entity type:Individual
Prefix:
First Name:SHAMA
Middle Name:
Last Name:SHAUKATALI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 FM 1959 RD STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-5416
Mailing Address - Country:US
Mailing Address - Phone:281-481-9400
Mailing Address - Fax:
Practice Address - Street 1:1311 W SAM HOUSTON PKWY N STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-4016
Practice Address - Country:US
Practice Address - Phone:832-219-3385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA115358363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant