Provider Demographics
NPI:1306655949
Name:MAHBOB, SAMIRA MOHAMMED
Entity type:Individual
Prefix:
First Name:SAMIRA
Middle Name:MOHAMMED
Last Name:MAHBOB
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 1:816 N BELL AVE APT 59
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-4280
Mailing Address - Country:US
Mailing Address - Phone:940-595-3675
Mailing Address - Fax:
Practice Address - Street 1:411 N WASHINGTON AVE STE 5200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1778
Practice Address - Country:US
Practice Address - Phone:855-204-2502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1182275363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health