Healthcare Provider Details

I. General information

NPI: 1710928593
Provider Name (Legal Business Name): ASSAD U. SHAFFIEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 CLINTON RD
SEDALIA MO
65301-7915
US

IV. Provider business mailing address

2925 CLINTON RD
SEDALIA MO
65301-7915
US

V. Phone/Fax

Practice location:
  • Phone: 660-829-5852
  • Fax: 660-829-5854
Mailing address:
  • Phone: 660-829-5852
  • Fax: 660-829-5854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number115544
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierG85947
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerMERCY
# 2
Identifier18833
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 3
Identifier9518
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 4
Identifier372430
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 5
Identifier392869
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerHEALTHLINK
# 6
Identifier1200057
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerUNITED HEALTHCARE
# 7
Identifier25282044
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerBCBS OF KANSAS CITY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: