Healthcare Provider Details

I. General information

NPI: 1366877243
Provider Name (Legal Business Name): SHIFA MENTAL HEALTH SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2781 PILOT KNOB RD
EAGAN MN
55121-1119
US

IV. Provider business mailing address

3044 170TH ST SW
PRIOR LAKE MN
55372-2334
US

V. Phone/Fax

Practice location:
  • Phone: 651-289-7300
  • Fax: 651-289-7301
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number50545
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number50545
License Number StateMN

VIII. Authorized Official

Name: SALIMA NAQVI
Title or Position: ORGANIZER
Credential: M.D
Phone: 612-386-5020