Provider Demographics
NPI:1124356597
Name:SHAFEEK, KAMARIA (PA)
Entity type:Individual
Prefix:MS
First Name:KAMARIA
Middle Name:
Last Name:SHAFEEK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 N GALLOWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2433
Mailing Address - Country:US
Mailing Address - Phone:972-697-6535
Mailing Address - Fax:
Practice Address - Street 1:1011 N GALLOWAY AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2433
Practice Address - Country:US
Practice Address - Phone:704-905-1868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001002094363A00000X
TXPA08091363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX314004802Medicaid
TXPA08091OtherSTATE LICENSE
NC001002094OtherNC PA LICENSE
NC001002094OtherNC PA LICENSE