Provider Demographics
NPI:1083455604
Name:WALI, SHAFIQ
Entity type:Individual
Prefix:
First Name:SHAFIQ
Middle Name:
Last Name:WALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 BOXELDER DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-6844
Mailing Address - Country:US
Mailing Address - Phone:480-667-2051
Mailing Address - Fax:
Practice Address - Street 1:356 BOXELDER DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-6844
Practice Address - Country:US
Practice Address - Phone:480-667-2051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT23270730103K00000X
VARBT23270730103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst