Provider Demographics
NPI:1669867925
Name:SHAMSI, SOHAIB (MD)
Entity type:Individual
Prefix:
First Name:SOHAIB
Middle Name:
Last Name:SHAMSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5514 CENTURY 21 BLVD APT 222
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-2125
Mailing Address - Country:US
Mailing Address - Phone:813-943-5858
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DRIVE
Practice Address - Street 2:RM. 4601
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-9149
Practice Address - Country:US
Practice Address - Phone:304-293-7215
Practice Address - Fax:304-293-6702
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WV27749207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program