Individual
SHAISTA ALAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
MT202598
PA
2084N0400X
Neurology Physician
Primary
MD457769
PA
Other
Enumeration date
06/22/2012
Last updated
10/27/2017
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