Provider Demographics
NPI:1003886888
Name:SHAFFIE, SOBIA H (MD)
Entity Type:Individual
Prefix:DR
First Name:SOBIA
Middle Name:H
Last Name:SHAFFIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17844 E 23RD ST S
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-1840
Mailing Address - Country:US
Mailing Address - Phone:816-836-6705
Mailing Address - Fax:816-257-2575
Practice Address - Street 1:17844 E 23RD ST S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1840
Practice Address - Country:US
Practice Address - Phone:816-836-6705
Practice Address - Fax:816-257-2575
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001641912084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208398008Medicaid
KS100098010BMedicaid
30130012OtherBCBS OF KC
30130012OtherBCBS OF KC
MO260050922Medicare ID - Type UnspecifiedRR
H25607Medicare UPIN
KS100098010BMedicaid