Healthcare Provider Details

I. General information

NPI: 1124461942
Provider Name (Legal Business Name): SHEFA RAHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 W TRUCKERS DR
FAYETTEVILLE AR
72704-5637
US

IV. Provider business mailing address

1955 W TRUCKERS DR
FAYETTEVILLE AR
72704-5637
US

V. Phone/Fax

Practice location:
  • Phone: 479-973-6000
  • Fax: 479-973-6050
Mailing address:
  • Phone: 479-973-6000
  • Fax: 479-973-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE-9096
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: