Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MT195624 | PA |
N | 208600000X | Surgeon | MT195624 | PA |
Y | 2086S0120X | Pediatric Surgery | ME141917 | FL |
NPI | 1295060119 |
---|---|
Provider Name | Dr. Shahab Shaffiey |
First Address | Miami, FL 33155-4070 |
Second Address | Miami, FL 33155-4070 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2009 |
Last Update Date | 02/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ME141917 | FLORIDA MEDICAL BOARD LICENSE (01) | FL |
MT195624 | MEDICAL TRAINING NUMBER (01) | PA |