Healthcare Provider Details

I. General information

NPI: 1558776450
Provider Name (Legal Business Name): SHAFAYET ALAM DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4508 LEGACY DR STE 200
PLANO TX
75024-2189
US

IV. Provider business mailing address

2320 CUP DR
PLANO TX
75074-2096
US

V. Phone/Fax

Practice location:
  • Phone: 469-551-8595
  • Fax:
Mailing address:
  • Phone: 972-207-0368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberP121104
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number692307
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: