Healthcare Provider Details

I. General information

NPI: 1982131256
Provider Name (Legal Business Name): SHIFA KANJWAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6202 HARRY HINES BLVD
DALLAS TX
75390-7709
US

IV. Provider business mailing address

PO BOX 845347
DALLAS TX
75284-7208
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-3999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberS5943
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberS5943
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: