Provider Demographics
NPI:1568976819
Name:ABU-SHAFE, NADA
Entity Type:Individual
Prefix:
First Name:NADA
Middle Name:
Last Name:ABU-SHAFE
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 1:2550 GRAY FALLS DR STE 100L
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-6674
Mailing Address - Country:US
Mailing Address - Phone:281-410-4293
Mailing Address - Fax:
Practice Address - Street 1:2550 GRAY FALLS DR STE 100L
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-6674
Practice Address - Country:US
Practice Address - Phone:281-410-4293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01774171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX713176946Medicaid