Provider Demographics
NPI:1487184552
Name:ABUSHAQRA, JAFAR M
Entity Type:Individual
Prefix:
First Name:JAFAR
Middle Name:M
Last Name:ABUSHAQRA
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 1:1840 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-2537
Mailing Address - Country:US
Mailing Address - Phone:937-262-8582
Mailing Address - Fax:
Practice Address - Street 1:1840 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-2537
Practice Address - Country:US
Practice Address - Phone:937-262-8582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty