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General NPI Number Information
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NPI Number | 1407889629
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Entity Type | Organization
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Legal Business Name | SHAFA CLINIC
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 609 5TH ST SW SUITE #3
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City | LIVE OAK
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State | FL
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Zip | 32064-2216
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Country | US
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Telephone | 386-362-6405
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Fax | 386-362-6403
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Provider Business Mailing Address
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Address Line | PO BOX 38
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City | LIVE OAK
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State | FL
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Zip | 32064-0038
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Country | US
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Telephone | 386-362-6405
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Fax | 386-362-6403
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ZAHOOR A WASEEM
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Credential | M.D.
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Telephone | 386-362-6405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME73901
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License Number State | FL
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