Provider Demographics
NPI:1609097773
Name:MEMON, SHAFIA SABA (MD)
Entity Type:Individual
Prefix:
First Name:SHAFIA
Middle Name:SABA
Last Name:MEMON
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 1:5055 E BROADWAY BLVD STE A100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3629
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-547-5797
Practice Address - Street 1:2222 N CRAYCROFT RD STE 150
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2816
Practice Address - Country:US
Practice Address - Phone:520-202-3488
Practice Address - Fax:520-202-3486
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD448143208000000X
CT54144208000000X
AZ68977208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028248590001Medicaid
TN1522266Medicaid
PA290055PC1Medicare PIN