Active NPI
Unknown Shisram, MSCMH, DSM, DMH
- Psychiatry Physician
- Pago Pago, AS
National Provider Identifier
1952758096
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 2182-C
- Practice address
- 96799 Turner Drive
Pago Pago, AS 96799-9994 - Phone
- (684) 633-1222
- Fax
- (684) 633-2893
- NPI assigned
- May 18, 2016
- Last updated
- May 18, 2016
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 2182-C | AS | Primary |
Addresses
Primary practice location
96799 Turner Drive
Pago Pago, AS 96799-9994
Mailing address
PO Box LBJ
Pago Pago, AS 96799-9994
Phone (684) 633-1222
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2182-C | AS | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463529600000",
"number": "1952758096",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX LBJ",
"city": "PAGO PAGO",
"state": "AS",
"postal_code": "967999994",
"telephone_number": "684-633-1222",
"fax_number": "684-633-2893"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "96799 TURNER DRIVE",
"city": "PAGO PAGO",
"state": "AS",
"postal_code": "967999994",
"telephone_number": "684-633-1222",
"fax_number": "684-633-2893"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHISRAM",
"first_name": "UNKNOWN",
"name_prefix": "Mr.",
"credential": "MSCMH, DSM, DMH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-05-18",
"last_updated": "2016-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "AS",
"license": "2182-C",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pago Pago, AS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.