Provider Demographics
NPI:1457709149
Name:NAFISI, SHIRIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRIN
Middle Name:
Last Name:NAFISI
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 1:9225 N 3RD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2466
Mailing Address - Country:US
Mailing Address - Phone:602-445-0751
Mailing Address - Fax:602-424-8128
Practice Address - Street 1:7400 E THOMPSON PEAK PKWY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4109
Practice Address - Country:US
Practice Address - Phone:602-445-0751
Practice Address - Fax:602-424-8128
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ58041207R00000X, 208M00000X
AZ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ558404Medicaid