Provider Demographics
NPI:1003257494
Name:SHIRE, ABDULHAKIM H (LPN NURSE)
Entity Type:Individual
Prefix:
First Name:ABDULHAKIM
Middle Name:H
Last Name:SHIRE
Suffix:
Gender:M
Credentials:LPN NURSE
Other - Prefix:
Other - First Name:ABDULHAKIM
Other - Middle Name:H
Other - Last Name:SHIRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:12/16/1957
Mailing Address - Street 1:484 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1145
Mailing Address - Country:US
Mailing Address - Phone:716-886-7108
Mailing Address - Fax:
Practice Address - Street 1:484 GRANT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1145
Practice Address - Country:US
Practice Address - Phone:716-886-7108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271676-1311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home