Healthcare Provider Details

I. General information

NPI: 1326326133
Provider Name (Legal Business Name): SHIFA PEDIATRIC CLINIC,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W WILLIAMS ST STE 102
APEX NC
27502-3978
US

IV. Provider business mailing address

5509 SOUTHERN CROSS AVE
RALEIGH NC
27606-4015
US

V. Phone/Fax

Practice location:
  • Phone: 919-300-7726
  • Fax: 919-300-7688
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: AYESHA SULTANA
Title or Position: PHYSICIAN
Credential:
Phone: 919-337-7350