Provider Demographics
NPI:1356576334
Name:SHAFI, HUMAIRA (MD)
Entity type:Individual
Prefix:
First Name:HUMAIRA
Middle Name:
Last Name:SHAFI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 W GLENDALE AVE
Mailing Address - Street 2:SUITE B 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-8194
Mailing Address - Country:US
Mailing Address - Phone:623-934-5600
Mailing Address - Fax:623-934-5603
Practice Address - Street 1:4225 W GLENDALE AVE
Practice Address - Street 2:SUITE B 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-8194
Practice Address - Country:US
Practice Address - Phone:623-934-5600
Practice Address - Fax:623-934-5603
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41398207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZCK3166OtherRAIL ROAD MEDICARE
AZZ130278Medicare PIN
AZCK3166OtherRAIL ROAD MEDICARE