Healthcare Provider Details

I. General information

NPI: 1033710652
Provider Name (Legal Business Name): SHAFFAQ ZAVERI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 FORBROOK LN NW
ROCHESTER MN
55901-4425
US

IV. Provider business mailing address

N7259 MEYER CT
HOLMEN WI
54636
US

V. Phone/Fax

Practice location:
  • Phone: 713-820-2380
  • Fax:
Mailing address:
  • Phone: 713-820-2380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number246441
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: