NPI Code Detail JSON Logo

1629622337 NPI number — SHABNAM KHALIFA

NPI Number: 1629622337
Health Care Provider/Practitioner: SHABNAM KHALIFA

Information about “1629622337” NPI (SHABNAM KHALIFA) exists in 1629622337 in HTML format HTML  |  1629622337 in plain Text format TXT  |  1629622337 in PDF (Portable Document Format) PDF  |  1629622337 in an XML format XML  formats.

NPI Number : 1629622337 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629622337",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KHALIFA",
    "FirstName": "SHABNAM",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5 MACY ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "AMESBURY",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "01913-3706",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "978-834-0300",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5 MACY ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AMESBURY",
    "PracticeLocationAddressStateName": "MA",
    "PracticeLocationAddressPostalCode": "01913-3706",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "978-834-3000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/31/2019",
    "LastUpdateDate": "09/23/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "0031202",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "3017541",
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "APRN03064",
          "LicenseNumberStateCode": "RI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WM0705X",
          "TaxonomyName": "Medical-Surgical Registered Nurse",
          "LicenseNumber": "RN2294164",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "NP500002239",
          "LicenseNumberStateCode": "DC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "11018215",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "101.0149386",
          "LicenseNumberStateCode": "VT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "53-81003-042",
          "LicenseNumberStateCode": "KS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "087557-23",
          "LicenseNumberStateCode": "NH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "CNP221121",
          "LicenseNumberStateCode": "ME",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "R253163",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "LG0011932",
          "LicenseNumberStateCode": "DE",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "RN2294164",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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