Provider Demographics
NPI:1013178805
Name:SHAFI, SADIA JAHAN
Entity Type:Individual
Prefix:
First Name:SADIA
Middle Name:JAHAN
Last Name:SHAFI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 DEFENSE HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-8943
Mailing Address - Country:US
Mailing Address - Phone:443-481-3354
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-224-0040
Practice Address - Fax:410-224-4232
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101248097207RC0000X
MDD75593207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program