Provider Demographics
NPI:1063814168
Name:SHAFEEQ, ADNAN DANIEL
Entity Type:Individual
Prefix:MR
First Name:ADNAN
Middle Name:DANIEL
Last Name:SHAFEEQ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10174 SAINT PAUL DR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-2772
Mailing Address - Country:US
Mailing Address - Phone:316-644-8934
Mailing Address - Fax:
Practice Address - Street 1:10174 SAINT PAUL DR
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2772
Practice Address - Country:US
Practice Address - Phone:316-644-8934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20141362354251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20141362354OtherSTATE OF COLORADO SEC. OF STATE