Provider Demographics
NPI:1649318403
Name:MIRZA, KHALED SHAMS
Entity type:Individual
Prefix:
First Name:KHALED
Middle Name:SHAMS
Last Name:MIRZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N DUPONT HWY
Mailing Address - Street 2:DELAWARE PSYCHIATRIC CENTER
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-1160
Mailing Address - Country:US
Mailing Address - Phone:302-255-2700
Mailing Address - Fax:
Practice Address - Street 1:1901 N DUPONT HWY
Practice Address - Street 2:DELAWARE PSYCHIATRIC CENTER
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-1160
Practice Address - Country:US
Practice Address - Phone:302-255-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC700032672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry