Provider Demographics
NPI:1972566834
Name:MAMDANI, SHAFIQ TAJDEN (MD)
Entity type:Individual
Prefix:
First Name:SHAFIQ
Middle Name:TAJDEN
Last Name:MAMDANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:BUILDING 15
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-5300
Mailing Address - Country:US
Mailing Address - Phone:401-228-2024
Mailing Address - Fax:401-228-2026
Practice Address - Street 1:450 VETERANS MEMORIAL PKWY
Practice Address - Street 2:BUILDING 15
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-5300
Practice Address - Country:US
Practice Address - Phone:401-228-2024
Practice Address - Fax:401-228-2026
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10667207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISM40959Medicaid
H42246Medicare UPIN
007060915Medicare PIN
007009116Medicare ID - Type Unspecified
RISM40959Medicaid