Provider Demographics
NPI:1396712915
Name:SHAKIR, SHAMA (MD)
Entity type:Individual
Prefix:
First Name:SHAMA
Middle Name:
Last Name:SHAKIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39533
Mailing Address - Country:US
Mailing Address - Phone:228-374-2494
Mailing Address - Fax:228-374-2713
Practice Address - Street 1:109 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-1604
Practice Address - Country:US
Practice Address - Phone:228-463-9666
Practice Address - Fax:228-463-0712
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17318208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125087Medicaid
MS00125087Medicaid
MS370000344Medicare PIN