Provider Demographics
NPI:1548147739
Name:MOSAFFA, SHAYAN (PHARMD)
Entity type:Individual
Prefix:
First Name:SHAYAN
Middle Name:
Last Name:MOSAFFA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MOUNT CARMEL WAY UNIT 213
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-4141
Mailing Address - Country:US
Mailing Address - Phone:774-519-1675
Mailing Address - Fax:
Practice Address - Street 1:104 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:NORTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01536-1021
Practice Address - Country:US
Practice Address - Phone:508-839-2240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH1002486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist