Provider Demographics
NPI:1407889629
Name:SHAFA CLINIC
Entity Type:Organization
Organization Name:SHAFA CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAHOOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:WASEEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-362-6405
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-0038
Mailing Address - Country:US
Mailing Address - Phone:386-362-6405
Mailing Address - Fax:386-362-6403
Practice Address - Street 1:609 5TH ST SW
Practice Address - Street 2:SUITE #3
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-2216
Practice Address - Country:US
Practice Address - Phone:386-362-6405
Practice Address - Fax:386-362-6403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73901174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1194811893OtherDANA NPI
FL1558303818OtherWASEEM NPI
FL1194811893OtherDANA NPI
FLG65979Medicare UPIN
FL108993Medicare ID - Type UnspecifiedRIVERBEND
FLE0381YMedicare ID - Type UnspecifiedMEDICAREDR W