Provider Demographics
NPI:1366877243
Name:SHIFA MENTAL HEALTH SERVICES PLLC
Entity type:Organization
Organization Name:SHIFA MENTAL HEALTH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:SALIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAQVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-386-5020
Mailing Address - Street 1:3044 170TH ST SW
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-2334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2781 PILOT KNOB RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1119
Practice Address - Country:US
Practice Address - Phone:651-289-7300
Practice Address - Fax:651-289-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X
MN505452084P0802X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1912041278Medicaid
MNH100102182OtherMDCR PTAN GROUP
MNH400102209OtherMEDICARE PTAN INDIVIDUAL