Provider Demographics
NPI:1740398270
Name:SHAFI, MOHAMMED (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:
Last Name:SHAFI
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 1:2700 CRIMSON CANYON DR
Mailing Address - Street 2:STE 180
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0802
Mailing Address - Country:US
Mailing Address - Phone:702-914-6555
Mailing Address - Fax:702-914-6556
Practice Address - Street 1:2136 E DESERT INN RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109
Practice Address - Country:US
Practice Address - Phone:702-914-6555
Practice Address - Fax:702-914-6556
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7391174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCH1004OtherRAILROAD MEDICARE
NVVWQBDL02Medicare ID - Type Unspecified
NVCH1004OtherRAILROAD MEDICARE