MEDICARE: IJAZ SHAFI MD

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	207W00000X	Ophthalmology Physician	015645	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	010015645CT01	OTHER	CT	ANTHEM

General Provider Information

NPI Number	:	1992788632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IJAZ SHAFI MD

Provider Business Mailing Address
First Line	:	1 GROVE ST
Second Line	:	2ND FLOOR
City	:	NEW BRITAIN
State	:	CT
Zip	:	06053-4116
Country	:	US
Telephone Number	:	860-224-7159
Fax Number	:	860-225-7122

Provider Business Practice Location Address
First Line	:	1 GROVE ST
Second Line	:	2ND FLOOR
City	:	NEW BRITAIN
State	:	CT
Zip	:	06053-4116
Country	:	US
Telephone Number	:	860-224-7159
Fax Number	:	860-225-7122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	03/29/2022

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Directions to “ IJAZ SHAFI MD” Practice Location

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