Healthcare Provider Details

I. General information

NPI: 1154687119
Provider Name (Legal Business Name): SHAHIK AREF CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 FOREST PLAZA DR
HIXSON TN
37343-5017
US

IV. Provider business mailing address

4321 FOREST PLAZA DR
HIXSON TN
37343-5017
US

V. Phone/Fax

Practice location:
  • Phone: 423-488-8960
  • Fax:
Mailing address:
  • Phone: 423-488-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberF01499
License Number StateTN

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: