Provider Demographics
NPI:1689887960
Name:JAVED K SHINWARI, MD,PA
Entity Type:Organization
Organization Name:JAVED K SHINWARI, MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHINWARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-329-1700
Mailing Address - Street 1:3025 FOUNTAIN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3025
Mailing Address - Country:US
Mailing Address - Phone:501-329-1700
Mailing Address - Fax:501-329-2440
Practice Address - Street 1:3025 FOUNTAIN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3025
Practice Address - Country:US
Practice Address - Phone:501-329-1700
Practice Address - Fax:501-329-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3091174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARG65093Medicare UPIN
AR5F166Medicare ID - Type Unspecified