Provider Demographics
NPI:1821670183
Name:SHAFIQ, MISBAH NUSRAT (OD)
Entity Type:Individual
Prefix:DR
First Name:MISBAH
Middle Name:NUSRAT
Last Name:SHAFIQ
Suffix:
Gender:F
Credentials:OD
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Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:13505 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:ASPEN HILL
Practice Address - State:MD
Practice Address - Zip Code:20906-2912
Practice Address - Country:US
Practice Address - Phone:301-438-0555
Practice Address - Fax:301-438-0556
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORAT4560152W00000X
MDTA2855152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist