Provider Demographics
NPI:1114954195
Name:RABBANI, SHAWN (DPM)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:RABBANI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18909 SHERMAN WAY STE B
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-7700
Mailing Address - Country:US
Mailing Address - Phone:818-344-6300
Mailing Address - Fax:818-774-9719
Practice Address - Street 1:18909 SHERMAN WAY STE B
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-7700
Practice Address - Country:US
Practice Address - Phone:818-344-6300
Practice Address - Fax:818-774-9719
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3914213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE3914AMedicare ID - Type Unspecified
CA0915720001Medicare NSC
CAU45953Medicare UPIN