Provider Demographics
NPI:1285929653
Name:KIANI, SHAMAS CHUNGEZ (MD)
Entity type:Individual
Prefix:DR
First Name:SHAMAS
Middle Name:CHUNGEZ
Last Name:KIANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAMAS
Other - Middle Name:
Other - Last Name:CHUNGEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13575 HILARY PATH
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-9574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL PARK BLVD
Practice Address - Street 2:200 MEDICAL PARK BLVD. .
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2380
Practice Address - Country:US
Practice Address - Phone:804-586-1431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291096-1207L00000X
IAMD-39576207L00000X
TXR1974207L00000X
VA0101265203207L00000X
MN60479207L00000X
FLME130943207L00000X
OK31239207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1285929653Medicaid
IA421417307-VAOtherUHC-RV
IA1285929653OtherWELLMARK
IA1285929653OtherWELLMARK