Provider Demographics
NPI:1861074239
Name:BANDEALI, SHAMA SALMAN
Entity type:Individual
Prefix:
First Name:SHAMA
Middle Name:SALMAN
Last Name:BANDEALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 MONARCH TRL
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-2522
Mailing Address - Country:US
Mailing Address - Phone:713-855-1682
Mailing Address - Fax:
Practice Address - Street 1:6624 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2312
Practice Address - Country:US
Practice Address - Phone:832-736-7554
Practice Address - Fax:832-900-4927
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX871632163W00000X
TX1035052363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty