Provider Demographics
NPI:1528750114
Name:AZZUBAIRI, SHAIMAA (DMD)
Entity type:Individual
Prefix:
First Name:SHAIMAA
Middle Name:
Last Name:AZZUBAIRI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 CREPEAU ST
Mailing Address - Street 2:103 APT
Mailing Address - City:SAINT LAURENT
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:H4N1N3
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1070 W MERCURY BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3378
Practice Address - Country:US
Practice Address - Phone:757-637-4203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014191371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice