Provider Demographics
NPI:1053683045
Name:JAFRI, SHAHEEN SYEDA (PT)
Entity Type:Individual
Prefix:
First Name:SHAHEEN
Middle Name:SYEDA
Last Name:JAFRI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15710 ROBLES DEL ORO
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-6430
Mailing Address - Country:US
Mailing Address - Phone:408-368-1282
Mailing Address - Fax:408-368-1282
Practice Address - Street 1:705 OAK GROVE AVE
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4319
Practice Address - Country:US
Practice Address - Phone:650-363-5674
Practice Address - Fax:650-363-5675
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06873ZMedicare PIN
CACA106221Medicare PIN