Provider Demographics
NPI:1306327481
Name:MUQAMUDIN, SHAMILA (RN)
Entity type:Individual
Prefix:
First Name:SHAMILA
Middle Name:
Last Name:MUQAMUDIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 CHINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-1375
Mailing Address - Country:US
Mailing Address - Phone:817-793-6005
Mailing Address - Fax:
Practice Address - Street 1:324 CHINCHESTER DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-1375
Practice Address - Country:US
Practice Address - Phone:817-793-6005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX949646163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse