Provider Demographics
NPI:1689943284
Name:FATIMA, SHAFIYA
Entity Type:Individual
Prefix:DR
First Name:SHAFIYA
Middle Name:
Last Name:FATIMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6747 FERNRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2745
Mailing Address - Country:US
Mailing Address - Phone:407-340-0928
Mailing Address - Fax:
Practice Address - Street 1:5280 S JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-5026
Practice Address - Country:US
Practice Address - Phone:407-363-7166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0037882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist