Provider Demographics
NPI:1316116080
Name:BODIE, SHAMANIQUE SHAMAONA (MD)
Entity type:Individual
Prefix:DR
First Name:SHAMANIQUE
Middle Name:SHAMAONA
Last Name:BODIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24010 THISTLEGATE CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-7382
Mailing Address - Country:US
Mailing Address - Phone:281-528-5146
Mailing Address - Fax:
Practice Address - Street 1:24010 THISTLEGATE CT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-7382
Practice Address - Country:US
Practice Address - Phone:281-528-5146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8542207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics