Provider Demographics
NPI:1548218662
Name:SHAFII, ABBASS (MD)
Entity Type:Individual
Prefix:DR
First Name:ABBASS
Middle Name:
Last Name:SHAFII
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 N WEBER ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1091
Mailing Address - Country:US
Mailing Address - Phone:719-473-6115
Mailing Address - Fax:719-473-3688
Practice Address - Street 1:715 N WEBER ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1091
Practice Address - Country:US
Practice Address - Phone:719-473-6115
Practice Address - Fax:719-473-3688
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34460174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01344605Medicaid
CO01344605Medicaid
CO398718Medicare ID - Type Unspecified