Shukufa Mansouri, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110007625 Issued in VA

Practice address

210 Towne Village Dr
Cary, NC 27513-8910

Phone

(919) 859-3373

NPI assigned

Jan 4, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Shukufa Abdul Wahab Mansouri Former name

Medicare fee-for-service enrollment

Enrolled in TX, GA, VA, DC, NC5 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 5

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MCV Associated PhysiciansGroup PAC ID 4385542117, 1,779 clinicians

Wake Emergency Physicians PAGroup PAC ID 9931002078, 269 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Community Memorial Hospital Hospital, South Hill, VA, CCN 490098
• Granville Health Systems Hospital, Oxford, NC, CCN 340127

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sabdulwahab1211128@valleyhealth.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wake Emergency Physicians PA

  • Emergency Medicine Physician
  • Raleigh, NC
  • NPI 1922063387
  Medicare reassignment Care Compare group
• MCV Associated Physicians

  • Anesthesiology Physician
  • Richmond, VA
  • NPI 1710959457
  Medicare reassignment Care Compare group
• Emergency Medicine Associates P.a., P.C.

  • Emergency Medicine Physician
  • Falls Church, VA
  • NPI 1134117393

  DC

  Medicare reassignment NPD
• Emergency Medicine Associates, P.a.,P.C.

  • Internal Medicine Physician
  • Dulles, VA
  • NPI 1376917070
  Medicare reassignment NPD
• Shenandoah Memorial Hospital, Inc.

  • Rural Health Clinic/Center
  • Woodstock, VA
  • NPI 1952417735
  Medicare reassignment NPD
• Acs Primary Care Physicians - Southeast PC

  • Emergency Medicine Physician
  • Myrtle Beach, SC
  • NPI 1861430555

  GA

  Medicare reassignment
• Acute Care Specialists

  • Emergency Medicine Physician
  • Longview, TX
  • NPI 1740655273
  Medicare reassignment
• CMH Physician Services, LLC

  • Internal Medicine Physician
  • South Hill, VA
  • NPI 1194760645
  Medicare reassignment
• Commonwealth Emergency Physicians PC

  • Emergency Medicine Physician
  • Leesburg, VA
  • NPI 1598723082
  Medicare reassignment
• Lake Spring Emergency Group, LLC

  • Emergency Medicine Physician
  • Salem, VA
  • NPI 1215429600
  Medicare reassignment
• CMH Physician Services, LLC

  • Hospitalist Physician
  • South Hill, VA
  • NPI 1386028793
  NPD
• Emergency Medicine Associates P.a., P.C.

  • Internal Medicine Physician
  • Culpeper, VA
  • NPI 1881559102
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Granville Health System

  • General Acute Care Hospital
  • Oxford, NC
  • NPI 1326061730
  Care Compare affiliation
• Community Memorial Hospital

  • General Acute Care Hospital
  • South Hill, VA
  • NPI 1336103738
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783987200000",
    "number": "1770171977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 TOWNE VILLAGE DR",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275138910",
            "telephone_number": "804-368-4302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 TOWNE VILLAGE DR",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275138910",
            "telephone_number": "919-859-3373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSOURI",
        "first_name": "SHUKUFA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-04",
        "last_updated": "2026-07-14",
        "certification_date": "2026-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110007625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHUKUFA",
            "last_name": "MANSOURI",
            "middle_name": "ABDUL WAHAB",
            "credential": "MANSOURI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ashley Manning, MSW, LCSW-A
• Mallory Manning, MHS, PA-C
• Olivia Manning, OTR/L
• Sarah Manson
• Fadi Mansour
• Kathryn Elizabeth Manton, O.D
• Macy Alexandra Mantooth, PA-C
• Arkevia Tyshay Marable
• Wayne J Marcelli
• Quinlan Ann Marchese

• Physician Assistant in Cary, NC
• Providers in Cary, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.