Provider Demographics
NPI:1073655338
Name:FAROOQUI, SHAMEELA DURRANI (MD)
Entity Type:Individual
Prefix:
First Name:SHAMEELA
Middle Name:DURRANI
Last Name:FAROOQUI
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 1:8404 E SHEA BLVD
Mailing Address - Street 2:100-B
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6659
Mailing Address - Country:US
Mailing Address - Phone:480-905-0000
Mailing Address - Fax:480-905-0041
Practice Address - Street 1:8404 E SHEA BLVD
Practice Address - Street 2:100-B
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6659
Practice Address - Country:US
Practice Address - Phone:480-905-0000
Practice Address - Fax:480-905-0041
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24639207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ359829Medicaid
AZ359829-07Medicaid
AZ70293Medicare ID - Type Unspecified
70293Medicare PIN
G35533Medicare UPIN
AZ359829-07Medicaid