Provider Demographics
NPI:1376108431
Name:ABBAS, SHAFI
Entity Type:Individual
Prefix:
First Name:SHAFI
Middle Name:
Last Name:ABBAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 CRYSTAL PL STE 1
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-1297
Mailing Address - Country:US
Mailing Address - Phone:502-550-6494
Mailing Address - Fax:
Practice Address - Street 1:604 CRYSTAL PL STE 1
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-1297
Practice Address - Country:US
Practice Address - Phone:502-550-6494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-04
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor