Healthcare Provider Details

I. General information

NPI: 1609097773
Provider Name (Legal Business Name): SHAFIA SABA MEMON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N CRAYCROFT RD STE 150
TUCSON AZ
85712-2816
US

IV. Provider business mailing address

5055 E BROADWAY BLVD STE A100
TUCSON AZ
85711-3629
US

V. Phone/Fax

Practice location:
  • Phone: 520-202-3488
  • Fax: 520-202-3486
Mailing address:
  • Phone: 520-327-0460
  • Fax: 520-547-5797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD448143
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number54144
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number68977
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1028248590001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1522266
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: