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General NPI Number Information
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NPI Number | 1760575914
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Entity Type | Organization
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Legal Business Name | SHAHINA H JAFRY MD SC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 6078 PALO VERDE DR
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City | ROCKFORD
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State | IL
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Zip | 61114
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Country | US
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Telephone | 815-398-9360
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Fax |
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Provider Business Mailing Address
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Address Line | 4525 FOREST VIEW AVE
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City | ROCKFORD
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State | IL
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Zip | 61108
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Country | US
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Telephone | 815-965-8505
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Fax | 815-965-8440
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Authorized Official
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Title or Position | CREDENTIALING AGENT
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Name | PETER E SMITH
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Credential |
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Telephone | 815-965-8505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036105570
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License Number State | IL
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