Provider Demographics
NPI:1194122341
Name:MAMO, SHELMITH (PMHNP)
Entity type:Individual
Prefix:
First Name:SHELMITH
Middle Name:
Last Name:MAMO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 MAIN ST STE 211
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-4439
Mailing Address - Country:US
Mailing Address - Phone:469-618-5703
Mailing Address - Fax:
Practice Address - Street 1:2770 MAIN ST STE 211
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4439
Practice Address - Country:US
Practice Address - Phone:469-618-5703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126843363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ092683Medicaid
AZ233336OtherLICENSE