Basic Information
| Provider Information | |||||||||
| NPI: | 1548721533 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAFAI | ||||||||
| FirstName: | ARIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 885 | ||||||||
| Address2: | |||||||||
| City: | ROCK HILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 127750885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455983908 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 NICOLLS RD | ||||||||
| Address2: | |||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117940001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314442968 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2019 | ||||||||
| LastUpdateDate: | 03/31/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.