Provider Demographics
NPI:1831262542
Name:JAFFRI, SHABANA M
Entity type:Individual
Prefix:DR
First Name:SHABANA
Middle Name:M
Last Name:JAFFRI
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SHABANA
Other - Middle Name:
Other - Last Name:MAHMOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 SWEETWATER DR APT K116
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-3214
Mailing Address - Country:US
Mailing Address - Phone:125-177-6052
Mailing Address - Fax:
Practice Address - Street 1:1108 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3022
Practice Address - Country:US
Practice Address - Phone:251-776-0521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD294402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry