MEDICARE: SHIFA NEUROLOGY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1760184741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIFA NEUROLOGY, PLLC

Provider Business Mailing Address
First Line	:	1473 EMERALD PINES DR
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-2231
Country	:	US
Telephone Number	:	734-578-3643
Fax Number	:

Provider Business Practice Location Address
First Line	:	1473 EMERALD PINES DR
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-2231
Country	:	US
Telephone Number	:	734-578-3643
Fax Number	:	734-721-9448

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NILOFER NISAR
Credential	:	MD
Telephone Number	:	734-578-3643

Provider Enumeration Date	:	03/21/2023
Last Update Date	:	09/18/2023

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