Basic Information
| Provider Information | |||||||||
| NPI: | 1437384856 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHIFA PSYCHIATRY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31480 N US HIGHWAY 45 | ||||||||
| Address2: | |||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600489444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476802715 | ||||||||
| FaxNumber: | 8476803832 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 TECHNOLOGY WAY | ||||||||
| Address2: | |||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600485364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476802715 | ||||||||
| FaxNumber: | 8476803832 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2009 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | TAYYAB | ||||||||
| AuthorizedOfficialFirstName: | SHAZIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PSYCHIATRIST | ||||||||
| AuthorizedOfficialTelephone: | 8476802715 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 036109759 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.