Provider Demographics
NPI:1073028189
Name:ABDULLAH, SHAAKIRA LATEEFA
Entity Type:Individual
Prefix:
First Name:SHAAKIRA
Middle Name:LATEEFA
Last Name:ABDULLAH
Suffix:
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 1:342 MACDONALD CLOSE
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-8303
Mailing Address - Country:US
Mailing Address - Phone:908-721-6039
Mailing Address - Fax:
Practice Address - Street 1:501 W 14TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1013
Practice Address - Country:US
Practice Address - Phone:302-428-4410
Practice Address - Fax:302-428-4078
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0051446163W00000X
NJ26NR16163700163W00000X
NJ26NJ00753400363LF0000X
DELG-0001093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse