Provider Demographics
NPI:1235489766
Name:SHAFFEEULLAH, IRSHAAD FARAZ (MD)
Entity Type:Individual
Prefix:
First Name:IRSHAAD
Middle Name:FARAZ
Last Name:SHAFFEEULLAH
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 1:13334 121 STREET
Mailing Address - Street 2:SOUTH OZONE PARK
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3240
Mailing Address - Country:US
Mailing Address - Phone:718-843-5378
Mailing Address - Fax:
Practice Address - Street 1:13334 121 STREET
Practice Address - Street 2:SOUTH OZONE PARK
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11420-3240
Practice Address - Country:US
Practice Address - Phone:718-843-5378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2164612084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry