Provider Demographics
NPI:1396231759
Name:SHAFI, FATIMA
Entity Type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:
Last Name:SHAFI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:FATIMA
Other - Middle Name:
Other - Last Name:SHAREEF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 AUGUSTA ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-1052
Mailing Address - Country:US
Mailing Address - Phone:847-505-6019
Mailing Address - Fax:
Practice Address - Street 1:175 N STEPHANIE ST STE 170
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8998
Practice Address - Country:US
Practice Address - Phone:702-997-5958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV70941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice