Provider Demographics
NPI:1881995652
Name:MAJID A. SHAMS, PHD, PA
Entity type:Organization
Organization Name:MAJID A. SHAMS, PHD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDOLMAJID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-753-5997
Mailing Address - Street 1:15940 PINE STRAND CT
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6365
Mailing Address - Country:US
Mailing Address - Phone:561-753-5997
Mailing Address - Fax:
Practice Address - Street 1:12788 W FOREST HILL BLVD
Practice Address - Street 2:1002
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4703
Practice Address - Country:US
Practice Address - Phone:561-753-5997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4959103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59444AMedicare PIN