Shafa Medical Clinic PC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

07569335N Issued in AZ

Legal business name

SHAFA MEDICAL CLINIC PC

Practice address

202 E Earll Dr Ste 150
Phoenix, AZ 85012-2636

Phone

(602) 248-8258

Fax

(602) 248-8259

NPI assigned

Nov 20, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Amanda Modesta, M.D.

Title

Medical Director /President

Phone

(602) 248-8258

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/18519/brand/1/csg/1/fhir/r4

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amanda Modesta Keyhani, MD

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1316993371
  Medicare reassignment
• Luis M Irizarry, MD

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1487658175
  NPD (past)
• Muzibul Chowdhury, M.D.

  • Internal Medicine Physician
  • Windsor, CT
  • NPI 1093730012
  NPD (past)
• Jaleh Tina Keyhani, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Fairfield, CA
  • NPI 1043214448
  NPD (past)
• Alan H Lozano, PA-C

  • Physician Assistant
  • New London, CT
  • NPI 1275843633
  NPD (past)
• M Hasan Yekta, MD

  • Pulmonary Disease Physician
  • East Hartford, CT
  • NPI 1669476016
  NPD (past)
• Sunil K Yerragondu

  • Internal Medicine Physician
  • East Hartford, CT
  • NPI 1912232646
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195516800000",
    "number": "1194906925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 E EARLL DR STE 150",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122636",
            "telephone_number": "602-248-8258",
            "fax_number": "602-248-8259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 E EARLL DR STE 150",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122636",
            "telephone_number": "602-248-8258",
            "fax_number": "602-248-8259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAFA MEDICAL CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-20",
        "last_updated": "2007-11-20",
        "status": "A",
        "authorized_official_last_name": "MODESTA",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR /PRESIDENT",
        "authorized_official_telephone_number": "602-248-8258",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AZ",
            "license": "07569335N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "447921",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "AZ0860140",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shad Misseldine, Inc.
• Sara Roya Shadaram, MD
• Shades of Service Transportation LLC
• Wael Shadid, LPC
• Linda Diane Shadley
• Mehrdad Shafa, MD
• Beth Shafer
• Brian L Shafer, M.D.
• Lauren Shafer
• Lauren Joy Shafer, PT

• Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.