Provider Demographics
NPI:1518042886
Name:YOUSAF, SHAGUFTA (MD)
Entity Type:Individual
Prefix:
First Name:SHAGUFTA
Middle Name:
Last Name:YOUSAF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 SW 59TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73119-7026
Mailing Address - Country:US
Mailing Address - Phone:405-208-7849
Mailing Address - Fax:405-212-2861
Practice Address - Street 1:2225 SW 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-7026
Practice Address - Country:US
Practice Address - Phone:405-208-7849
Practice Address - Fax:405-212-2861
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP810208000000X
KY40626208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64128671Medicaid