Provider Demographics
NPI:1134303316
Name:SIDANI, SHAFIK MUSTAFA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAFIK
Middle Name:MUSTAFA
Last Name:SIDANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1625 N GEORGE MASON DR
Mailing Address - Street 2:SUITE 454
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3683
Mailing Address - Country:US
Mailing Address - Phone:703-717-4180
Mailing Address - Fax:703-717-4181
Practice Address - Street 1:1625 N GEORGE MASON DR
Practice Address - Street 2:SUITE 454
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3683
Practice Address - Country:US
Practice Address - Phone:703-717-4180
Practice Address - Fax:703-717-4181
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101253957174400000X, 208C00000X
MN55164208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery