Provider Demographics
NPI:1881698371
Name:SHAFAIEH, SHAFI (MD)
Entity type:Individual
Prefix:DR
First Name:SHAFI
Middle Name:
Last Name:SHAFAIEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HWY 91 S #103
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725
Mailing Address - Country:US
Mailing Address - Phone:406-683-6861
Mailing Address - Fax:406-683-1180
Practice Address - Street 1:30 HWY 91 S #103
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725
Practice Address - Country:US
Practice Address - Phone:406-683-6861
Practice Address - Fax:406-683-1180
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4966208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery