Provider Demographics
NPI:1043799117
Name:ABDALA, SHADIYA A I
Entity Type:Individual
Prefix:MISS
First Name:SHADIYA
Middle Name:A
Last Name:ABDALA
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4642 BELVEDERE PARK
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-6366
Mailing Address - Country:US
Mailing Address - Phone:614-285-1124
Mailing Address - Fax:
Practice Address - Street 1:1535 GEORGESVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-3615
Practice Address - Country:US
Practice Address - Phone:614-285-1124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)