Provider Demographics
NPI:1356669378
Name:AHMED, SHAMSHAD (CPO)
Entity type:Individual
Prefix:MR
First Name:SHAMSHAD
Middle Name:
Last Name:AHMED
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 26TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1630
Mailing Address - Country:US
Mailing Address - Phone:304-942-5352
Mailing Address - Fax:
Practice Address - Street 1:223 26TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-1630
Practice Address - Country:US
Practice Address - Phone:304-942-5352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2015-04-20
Deactivation Date:2010-11-24
Deactivation Code:
Reactivation Date:2015-04-20
Provider Licenses
StateLicense IDTaxonomies
VACPO 02136222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV27-2425314OtherEIN