Healthcare Provider Details

I. General information

NPI: 1205045994
Provider Name (Legal Business Name): SALMAN T SHAFI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 SOUTHWESTERN RUN
POLAND OH
44514-3688
US

IV. Provider business mailing address

807 SOUTHWESTERN RUN
POLAND OH
44514-3688
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-0059
  • Fax: 330-729-9297
Mailing address:
  • Phone: 330-729-0059
  • Fax: 330-729-9297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35-091497
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: