Provider Demographics
NPI:1598543191
Name:SHABAZZ, RASHEED HASSAN
Entity Type:Individual
Prefix:
First Name:RASHEED
Middle Name:HASSAN
Last Name:SHABAZZ
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 1:2242 NE 121ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-1838
Mailing Address - Country:US
Mailing Address - Phone:503-995-1793
Mailing Address - Fax:
Practice Address - Street 1:621 SW ALDER ST STE 520
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3620
Practice Address - Country:US
Practice Address - Phone:503-494-4745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program