Provider Demographics
NPI:1548736259
Name:SHAIBU, NUREIN MIGYIMAH
Entity Type:Individual
Prefix:
First Name:NUREIN
Middle Name:MIGYIMAH
Last Name:SHAIBU
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 1:1342 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-8663
Mailing Address - Country:US
Mailing Address - Phone:646-944-9582
Mailing Address - Fax:480-508-1148
Practice Address - Street 1:1342 W PARK AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-8663
Practice Address - Country:US
Practice Address - Phone:480-508-1147
Practice Address - Fax:480-508-1148
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH5555103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)