Provider Demographics
NPI:1053055764
Name:SHAFIQ, NIMRA (MD)
Entity Type:Individual
Prefix:MRS
First Name:NIMRA
Middle Name:
Last Name:SHAFIQ
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 1:8423 MARKET STREET. SUITE 101
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512
Mailing Address - Country:US
Mailing Address - Phone:330-729-8700
Mailing Address - Fax:330-729-8701
Practice Address - Street 1:8423 MARKET STREET. SUITE 101
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512
Practice Address - Country:US
Practice Address - Phone:330-729-8700
Practice Address - Fax:330-729-8701
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.253046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine