Healthcare Provider Details

I. General information

NPI: 1336054808
Provider Name (Legal Business Name): NORTH SHORE WELLNESS INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 DODGE ST
BEVERLY MA
01915-1711
US

IV. Provider business mailing address

30 HIGH ST STE 1
NORTH ANDOVER MA
01845-2620
US

V. Phone/Fax

Practice location:
  • Phone: 917-767-1104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: ZAKA SHAFIQ
Title or Position: SECRETARY AND TREASURER
Credential:
Phone: 917-767-1104