Provider Demographics
NPI:1245397348
Name:HAKIM, SAFAA SHAKIK (MD)
Entity Type:Individual
Prefix:DR
First Name:SAFAA
Middle Name:SHAKIK
Last Name:HAKIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SAFAA
Other - Middle Name:SHAKIK
Other - Last Name:REZUALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 CASE STREET
Mailing Address - Street 2:SUITE 307
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:860-886-9114
Mailing Address - Fax:860-204-0297
Practice Address - Street 1:12 CASE STREET
Practice Address - Street 2:SUITE 307
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-886-9114
Practice Address - Fax:860-204-0297
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0285382084P0800X
CT0285832084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
260002167Medicare ID - Type Unspecified
E56769Medicare UPIN