Provider Demographics
NPI:1811675168
Name:JAFRI, SHAZA IMAD (MBBS)
Entity type:Individual
Prefix:MRS
First Name:SHAZA
Middle Name:IMAD
Last Name:JAFRI
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W PARK ST CARLE FOUNDATION HOSPITAL
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801
Mailing Address - Country:US
Mailing Address - Phone:217-549-6585
Mailing Address - Fax:
Practice Address - Street 1:611 W PARK ST CARLE FOUNDATION HOSPITAL
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801
Practice Address - Country:US
Practice Address - Phone:217-383-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2024-02-16
Deactivation Date:2024-02-08
Deactivation Code:
Reactivation Date:2024-02-16
Provider Licenses
StateLicense IDTaxonomies
IL125.082166207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine