Provider Demographics
NPI:1275315889
Name:VAFAI, SHAKIBA (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHAKIBA
Middle Name:
Last Name:VAFAI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 KELVIN AVE APT 241
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-0107
Mailing Address - Country:US
Mailing Address - Phone:949-468-7482
Mailing Address - Fax:
Practice Address - Street 1:3991 MACARTHUR BLVD # 340A
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3009
Practice Address - Country:US
Practice Address - Phone:949-732-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF10230540363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily