Provider Demographics
NPI:1760205389
Name:SHAH, AFAQ ALI
Entity type:Individual
Prefix:MR
First Name:AFAQ
Middle Name:ALI
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2242 STONEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-8120
Mailing Address - Country:US
Mailing Address - Phone:312-863-9386
Mailing Address - Fax:
Practice Address - Street 1:2242 STONEHAVEN DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-8120
Practice Address - Country:US
Practice Address - Phone:312-863-9386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-02
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171R00000X, 374U00000X, 171W00000X
ILS000-0018-7319172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No171R00000XOther Service ProvidersInterpreter
No172A00000XOther Service ProvidersDriver
No374U00000XNursing Service Related ProvidersHome Health Aide