Provider Demographics
NPI:1104109347
Name:MAHMOOD, SHESHANA NINA
Entity type:Individual
Prefix:MISS
First Name:SHESHANA
Middle Name:NINA
Last Name:MAHMOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7370 170TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4457
Mailing Address - Country:US
Mailing Address - Phone:425-895-8113
Mailing Address - Fax:425-885-2923
Practice Address - Street 1:7370 170TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4457
Practice Address - Country:US
Practice Address - Phone:425-895-8113
Practice Address - Fax:425-885-2923
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA 60053697183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician