Healthcare Provider Details

I. General information

NPI: 1760184741
Provider Name (Legal Business Name): SHIFA NEUROLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1473 EMERALD PINES DR
CANTON MI
48188-2231
US

IV. Provider business mailing address

1473 EMERALD PINES DR
CANTON MI
48188-2231
US

V. Phone/Fax

Practice location:
  • Phone: 734-578-3643
  • Fax: 734-721-9448
Mailing address:
  • Phone: 734-578-3643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: NILOFER NISAR
Title or Position: PRESIDENT
Credential: MD
Phone: 734-578-3643