Provider Demographics
NPI:1497833453
Name:SAEED-KHAWAJA, SHUMYLA (MD)
Entity type:Individual
Prefix:
First Name:SHUMYLA
Middle Name:
Last Name:SAEED-KHAWAJA
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 1:924 W LITTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-2024
Mailing Address - Country:US
Mailing Address - Phone:757-440-0719
Mailing Address - Fax:757-440-7981
Practice Address - Street 1:924 W LITTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-2024
Practice Address - Country:US
Practice Address - Phone:757-440-0719
Practice Address - Fax:757-440-7981
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246270208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1497833453Medicaid