Healthcare Provider Details

I. General information

NPI: 1124223318
Provider Name (Legal Business Name): MOUHSIN SHAFI MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST WANG 735
BOSTON MA
02114-2621
US

IV. Provider business mailing address

330 MT AUBURN ST PARSONS 2
CAMBRIDGE MA
02138-5597
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-1067
  • Fax: 617-726-2353
Mailing address:
  • Phone: 617-499-5054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number239159
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number239159
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: