1982993747 NPI number — DR. SHAHENDA SAMIR ALY M.D

Table of content: DR. SHAHENDA SAMIR ALY M.D (NPI 1982993747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982993747 NPI number — DR. SHAHENDA SAMIR ALY M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALY
Provider First Name:
SHAHENDA
Provider Middle Name:
SAMIR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982993747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9214
Provider Second Line Business Mailing Address:
ROBERT C. BYRD HEALTH SCIENCES CENTER - DEPT OF PEDS
Provider Business Mailing Address City Name:
MORGANTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26506-9214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-293-4451
Provider Business Mailing Address Fax Number:
304-293-4341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WEST VIRGINIA UNIVERSITY HOSPITALS SCHOOL OF MEDICINE
Provider Second Line Business Practice Location Address:
DEPT OF PEDIATRICS ROBERT C BYRD HEALTH SCIENCE CENTER
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26506-9214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-293-4451
Provider Business Practice Location Address Fax Number:
304-293-4341
Provider Enumeration Date:
04/01/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)