Active NPI
Shaista Khanum, MD
- Family Medicine Physician
- Augusta, ME
National Provider Identifier
1932212230
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- EC061112
- Practice address
- 15 E Chestnut St
Augusta, ME 04330-5736 - Phone
- (207) 626-1561
- Fax
- (207) 626-1849
- NPI assigned
- Aug 17, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | EC061112 | ME | Primary |
Addresses
Primary practice location
15 E Chestnut St
Augusta, ME 04330-5736
Mailing address
150 Dresden Ave
Gardiner, ME 04345-2615
Phone (207) 621-9337
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NONE | Other | ME | RESIDENT-NO PROV # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| EC061112 | ME | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1932212230",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 DRESDEN AVE",
"city": "GARDINER",
"state": "ME",
"postal_code": "043452615",
"telephone_number": "207-621-9337",
"fax_number": "207-621-3609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 E CHESTNUT ST",
"city": "AUGUSTA",
"state": "ME",
"postal_code": "043305736",
"telephone_number": "207-626-1561",
"fax_number": "207-626-1849"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHANUM",
"first_name": "SHAISTA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ME",
"license": "EC061112",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RESIDENT-NO PROV #",
"identifier": "NONE",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Augusta, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.