Provider Demographics
NPI:1326852765
Name:QAYYUM, MAHEEN (PA-C)
Entity type:Individual
Prefix:
First Name:MAHEEN
Middle Name:
Last Name:QAYYUM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14985 CONWAY RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2049
Mailing Address - Country:US
Mailing Address - Phone:314-550-5633
Mailing Address - Fax:
Practice Address - Street 1:14985 CONWAY RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2049
Practice Address - Country:US
Practice Address - Phone:314-550-5633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical