Healthcare Provider Details

I. General information

NPI: 1508838533
Provider Name (Legal Business Name): SHEHLA ALAVI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 CENEX DR MAIL STOP 33100A
INVER GROVE HEIGHTS MN
55077-1724
US

IV. Provider business mailing address

8100 34TH AVE S MC21110Q
BLOOMINGTON MN
55425-1672
US

V. Phone/Fax

Practice location:
  • Phone: 651-552-2600
  • Fax: 651-552-2614
Mailing address:
  • Phone: 952-883-7172
  • Fax: 952-883-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number41131
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: