Provider Demographics
NPI:1699056853
Name:SOHRAB SHAFII MD PA
Entity type:Organization
Organization Name:SOHRAB SHAFII MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOHRAB
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFII
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-875-0989
Mailing Address - Street 1:PO BOX 151807
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33684-1807
Mailing Address - Country:US
Mailing Address - Phone:813-875-0989
Mailing Address - Fax:813-871-3902
Practice Address - Street 1:4710 N HABANA AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7161
Practice Address - Country:US
Practice Address - Phone:813-875-0989
Practice Address - Fax:813-871-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME28697207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039228600Medicaid
FL30296Medicare PIN
FL039228600Medicaid