Provider Demographics
NPI:1083941876
Name:SHAHAB, NIDA (PHARMD)
Entity Type:Individual
Prefix:
First Name:NIDA
Middle Name:
Last Name:SHAHAB
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 EMPIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-3121
Mailing Address - Country:US
Mailing Address - Phone:718-221-6814
Mailing Address - Fax:718-221-6815
Practice Address - Street 1:525 EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3121
Practice Address - Country:US
Practice Address - Phone:718-221-6814
Practice Address - Fax:718-221-6815
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist