Provider Demographics
NPI:1710928593
Name:SHAFFIEY, ASSAD U (MD)
Entity Type:Individual
Prefix:
First Name:ASSAD
Middle Name:U
Last Name:SHAFFIEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2925 CLINTON RD
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-7915
Mailing Address - Country:US
Mailing Address - Phone:660-829-5852
Mailing Address - Fax:660-829-5854
Practice Address - Street 1:2925 CLINTON RD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-7915
Practice Address - Country:US
Practice Address - Phone:660-829-5852
Practice Address - Fax:660-829-5854
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO115544208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG85947OtherMERCY
MO18833Medicaid
MO9518Medicaid
MO372430Medicaid
MO392869OtherHEALTHLINK
MO1200057OtherUNITED HEALTHCARE
MO25282044OtherBCBS OF KANSAS CITY