Provider Demographics
NPI:1043753759
Name:ABO ALABAS SHAHAWAN, REHAB
Entity Type:Individual
Prefix:
First Name:REHAB
Middle Name:
Last Name:ABO ALABAS SHAHAWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REHAB
Other - Middle Name:
Other - Last Name:SHAHAWAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1257 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-2905
Mailing Address - Country:US
Mailing Address - Phone:718-681-7553
Mailing Address - Fax:
Practice Address - Street 1:1257 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-2905
Practice Address - Country:US
Practice Address - Phone:718-681-7553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025378235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist