1356576334 NPI number — HUMAIRA SHAFI M.D.

Table of content: HUMAIRA SHAFI M.D. (NPI 1356576334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356576334 NPI number — HUMAIRA SHAFI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAFI
Provider First Name:
HUMAIRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356576334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4225 W GLENDALE AVE
Provider Second Line Business Mailing Address:
SUITE B 200
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85051-8194
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-934-5600
Provider Business Mailing Address Fax Number:
623-934-5603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4225 W GLENDALE AVE
Provider Second Line Business Practice Location Address:
SUITE B 200
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85051-8194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-934-5600
Provider Business Practice Location Address Fax Number:
623-934-5603
Provider Enumeration Date:
05/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  41398 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CK3166 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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