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General NPI Number Information
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NPI Number | 1205634847
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Entity Type | Organization
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Legal Business Name | SHANI RE LLC
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 525 RANDALL AVE
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City | CHEYENNE
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State | WY
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Zip | 82001
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Country | US
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Telephone | 307-201-3715
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Fax |
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Provider Business Mailing Address
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Address Line | 525 RANDALL AVE STE 100 PMB266
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City | CHEYENNE
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State | WY
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Zip | 82001-2772
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Country | US
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Telephone | 307-201-3715
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | IRFAN NAWAZ
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Credential | DIRECTOR
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Telephone | 307-201-3715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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