Healthcare Provider Details

I. General information

NPI: 1528033693
Provider Name (Legal Business Name): WALEED WASFY SHINDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S RAYMOND AVE SUITE 240
PASADENA CA
91105-3278
US

IV. Provider business mailing address

630 S RAYMOND AVE SUITE 240
PASADENA CA
91105-3278
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-9920
  • Fax: 626-578-7366
Mailing address:
  • Phone: 626-449-9920
  • Fax: 626-578-7366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA068992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: