Provider Demographics
NPI:1669963807
Name:NOORMOHAMMAD, SHAISTA (MD)
Entity type:Individual
Prefix:
First Name:SHAISTA
Middle Name:
Last Name:NOORMOHAMMAD
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 1:2607 WHITEHALL LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8410
Mailing Address - Country:US
Mailing Address - Phone:618-751-2545
Mailing Address - Fax:609-441-8907
Practice Address - Street 1:4225 ALTAMONT PL STE 201
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3065
Practice Address - Country:US
Practice Address - Phone:240-607-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD0091953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program