Olivia Sumia Shadid
Individual provider Active NPI Child & Adolescent Psychiatry Physician · Albuquerque, NM
NPI 1750844403 · NPPES record last updated Jul 31, 2024
Key facts
- NPI
- 1750844403
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Child & Adolescent Psychiatry Physician 2084P0804X
- License
- MD2022-1190 (NM)
- Practice address
- 1 University of New Mexico Msc09 5030
Albuquerque, NM 87131-0001 - Phone
- (505) 272-5428
- NPI assigned
- Apr 10, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240522002350 | TX | Practitioner - Psychiatry | 1456688217 | Reassigns benefits to 1 organization |
| I20240814005069 | NM | Practitioner - Psychiatry | 1456688217 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD2022-1190 | NM | MD | Child & Adolescent Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Unm Medical Group Inc | Current |
Accepting new patients | |
| Unm Medical Group, Inc. | Current |
Accepting new patients | |
| DHHS,PHS,Naihs, Gallup Indian Medical Center | Current |
Accepting new patients |
Locations
800 Bradbury Dr SE
Ste 116
Albuquerque, NM 87106
Phone (505) 272-1476
516 E Nizhoni Blvd
Gallup, NM 87301
Phone (505) 722-1326
2211 Lomas Blvd NE
Unm, NM 87106
Phone (505) 272-1111
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD2022-1190 | NM | |
| Student in an Organized Health Care Education/Training Program | 390200000X | NM | ||
| Child & Adolescent Psychiatry Physician | 2084P0804X | MD2022-1190 | NM | Yes |
Addresses
Primary practice location
1 University of New Mexico Msc09 5030
Albuquerque, NM 87131-0001
Mailing address
1 University of New Mexico Msc09 5030
Albuquerque, NM 87131-0001
Phone (505) 272-5428
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | UNMMG@direct.health.unm.edu | ||
| Direct Messaging Address | UNMH@direct.health.unm.edu |
Other providers in Albuquerque, NM
- Carolyne Sewell
- Matthew Todd Sewell
- Susan Sewell
- Sfaba NM LLC
- Tyler Ray Shackelford
- Neal Shadoff
- Shadow Mountain Health LLC.
- Shadow Mountain LLC.
- Shadow Mountain Recovery LLC.
- Darren M Shafer
All providers in Albuquerque, NM · Child & Adolescent Psychiatry Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.