Provider Demographics
NPI:1477896439
Name:SHABAZZ, AMINAH
Entity Type:Individual
Prefix:
First Name:AMINAH
Middle Name:
Last Name:SHABAZZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMINAH
Other - Middle Name:
Other - Last Name:SHABAZZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:3506 DAYTONA AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-6412
Mailing Address - Country:US
Mailing Address - Phone:513-372-5253
Mailing Address - Fax:
Practice Address - Street 1:3506 DAYTONA AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-6412
Practice Address - Country:US
Practice Address - Phone:513-372-5253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH145170164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse