Provider Demographics
NPI:1558123596
Name:SHADAB, HUSNA
Entity Type:Individual
Prefix:
First Name:HUSNA
Middle Name:
Last Name:SHADAB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-5216
Mailing Address - Country:US
Mailing Address - Phone:916-235-8457
Mailing Address - Fax:
Practice Address - Street 1:6820 HAVENHURST DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-2710
Practice Address - Country:US
Practice Address - Phone:916-385-8529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker