Provider Demographics
NPI:1114565041
Name:SHAMS, SHAFAY MUHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAFAY
Middle Name:MUHAMMAD
Last Name:SHAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5970 CHURCHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-2574
Mailing Address - Country:US
Mailing Address - Phone:815-971-8990
Mailing Address - Fax:815-971-9978
Practice Address - Street 1:5970 CHURCHVIEW DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-2574
Practice Address - Country:US
Practice Address - Phone:815-971-8990
Practice Address - Fax:815-971-9978
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036164991207R00000X
390200000X
LA336477207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program