Provider Demographics
NPI:1225850761
Name:SHAFIE, IFRAH S (PMHNP)
Entity type:Individual
Prefix:
First Name:IFRAH
Middle Name:S
Last Name:SHAFIE
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13946 W PRESERVE BLVD
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-7728
Mailing Address - Country:US
Mailing Address - Phone:952-594-1062
Mailing Address - Fax:
Practice Address - Street 1:5270 W 84TH ST STE 370
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-1377
Practice Address - Country:US
Practice Address - Phone:952-395-5223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2024086274363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health