Provider Demographics
NPI:1093973687
Name:MUFTI, SHAYASTA SHAHEEN
Entity Type:Individual
Prefix:DR
First Name:SHAYASTA
Middle Name:SHAHEEN
Last Name:MUFTI
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 1:1227 KING JAMES CT
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-4743
Mailing Address - Country:US
Mailing Address - Phone:813-420-8756
Mailing Address - Fax:
Practice Address - Street 1:1227 KING JAMES CT
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-4743
Practice Address - Country:US
Practice Address - Phone:813-420-8756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD450561207R00000X, 208M00000X
NC2018-00579207R00000X
DEC1-0009948207R00000X
LA308133207R00000X
NY292356207R00000X
METD121031207R00000X
VA0101251621207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist