Provider Demographics
NPI:1063643278
Name:SHALOM, MATSAYAH S (CPM, LM)
Entity type:Individual
Prefix:MRS
First Name:MATSAYAH
Middle Name:S
Last Name:SHALOM
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 COUNTY ROAD 3222
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75451-4008
Mailing Address - Country:US
Mailing Address - Phone:903-856-2728
Mailing Address - Fax:
Practice Address - Street 1:43 COUNTY ROAD 3222
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:TX
Practice Address - Zip Code:75451-4008
Practice Address - Country:US
Practice Address - Phone:903-856-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99081176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife