Provider Demographics
NPI:1265625727
Name:MOUSTARAH AMMAR, SHADIA
Entity type:Individual
Prefix:
First Name:SHADIA
Middle Name:
Last Name:MOUSTARAH AMMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 GLENGATE CIR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6959
Mailing Address - Country:US
Mailing Address - Phone:919-200-4404
Mailing Address - Fax:
Practice Address - Street 1:1035 GLENGATE CIR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6959
Practice Address - Country:US
Practice Address - Phone:919-200-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-19
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6569225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist