Healthcare Provider Details

I. General information

NPI: 1184151508
Provider Name (Legal Business Name): SHIFA COMPREHENSIVE HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 05/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 WEST AVE SUITE 204
LUDLOW MA
01056-1700
US

IV. Provider business mailing address

185 WEST AVE SUITE 204
LUDLOW MA
01056-1700
US

V. Phone/Fax

Practice location:
  • Phone: 413-610-2201
  • Fax:
Mailing address:
  • Phone: 413-610-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ZUHAIR MATIN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 413-348-4343