Healthcare Provider Details

I. General information

NPI: 1265591507
Provider Name (Legal Business Name): SHEHLA JAFFERY-KHALIL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHEHLA T. JAFFERY M.D.

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HENRY FORD HEALTH SYSTEM 2825 LIVERNOIS
TROY MI
48083
US

IV. Provider business mailing address

HENRY FORD HEALTH SYSTEM 2825 LIVERNOIS
TROY MI
48083
US

V. Phone/Fax

Practice location:
  • Phone: 248-680-6000
  • Fax: 248-680-6068
Mailing address:
  • Phone: 248-680-6000
  • Fax: 248-680-6068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301057909
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301057909
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: