Provider Demographics
NPI:1992788632
Name:SHAFI, IJAZ (MD)
Entity type:Individual
Prefix:
First Name:IJAZ
Middle Name:
Last Name:SHAFI
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 1:1 GROVE ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-4116
Mailing Address - Country:US
Mailing Address - Phone:860-224-7159
Mailing Address - Fax:860-225-7122
Practice Address - Street 1:1 GROVE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-4116
Practice Address - Country:US
Practice Address - Phone:860-224-7159
Practice Address - Fax:860-225-7122
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT015645207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008008150Medicaid
CT010015645CT01OtherANTHEM
CT0374470001Medicare NSC
CT010015645CT01OtherANTHEM