Provider Demographics
NPI:1609401918
Name:SHABAZZ, JASMIN (CNA)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:
Last Name:SHABAZZ
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TORLINA CT APT B
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5147
Mailing Address - Country:US
Mailing Address - Phone:443-889-2336
Mailing Address - Fax:
Practice Address - Street 1:11 TORLINA CT APT B
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-5147
Practice Address - Country:US
Practice Address - Phone:443-889-2336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00110761376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide