Provider Demographics
NPI:1740368646
Name:SHAIBANI, BANAFSHEH B (MD)
Entity type:Individual
Prefix:
First Name:BANAFSHEH
Middle Name:B
Last Name:SHAIBANI
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 1:48 ARBORSIDE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-0111
Mailing Address - Country:US
Mailing Address - Phone:949-887-4109
Mailing Address - Fax:
Practice Address - Street 1:48 ARBORSIDE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603-0111
Practice Address - Country:US
Practice Address - Phone:949-887-4109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91872207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A918720Medicaid
00A918720Medicare ID - Type Unspecified
I47987Medicare UPIN