Provider Demographics
NPI:1396231759
Name:SHAFI, FATIMA
Entity type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:
Last Name:SHAFI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:FATIMA
Other - Middle Name:
Other - Last Name:SHAREEF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3084 ST GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2517
Mailing Address - Country:US
Mailing Address - Phone:847-505-6019
Mailing Address - Fax:
Practice Address - Street 1:813 FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2605
Practice Address - Country:US
Practice Address - Phone:626-593-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1102191223G0001X
NV70941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice