Provider Demographics
NPI:1588788830
Name:GHAFOORI, SHELLEY DAY (MD)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:DAY
Last Name:GHAFOORI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:801 W 38TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1167
Mailing Address - Country:US
Mailing Address - Phone:512-451-0103
Mailing Address - Fax:512-451-2741
Practice Address - Street 1:801 W 38TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1167
Practice Address - Country:US
Practice Address - Phone:512-451-0103
Practice Address - Fax:512-451-2741
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4858207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3127094-03Medicaid
TX3127094-01Medicaid
TX3127094-02Medicaid
TX3127094-04Medicaid
TX3127094-03Medicaid
TX3127094-02Medicaid