MEDICARE: MISS SHOHREH SHAFFIE MFTI39241

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	39241	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	COUNTY ID	OTHER	CA	MFTI

General Provider Information

NPI Number	:	1356412993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHOHREH SHAFFIE MFTI39241

Provider Business Mailing Address
First Line	:	20488 STEVENS CREEK BLVD
Second Line	:
City	:	CUPERTINO
State	:	CA
Zip	:	95014-2281
Country	:	US
Telephone Number	:	408-876-4128
Fax Number	:

Provider Business Practice Location Address
First Line	:	20488 STEVENS CREEK BLVD
Second Line	:
City	:	CUPERTINO
State	:	CA
Zip	:	95014-2281
Country	:	US
Telephone Number	:	408-876-4128
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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