Provider Demographics
NPI:1679802037
Name:SHABNAM, SHIVA NANCY (MD)
Entity Type:Individual
Prefix:
First Name:SHIVA
Middle Name:NANCY
Last Name:SHABNAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10800 PARAMOUNT BLVD
Mailing Address - Street 2:406
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3331
Mailing Address - Country:US
Mailing Address - Phone:562-869-1070
Mailing Address - Fax:562-869-6317
Practice Address - Street 1:10800 PARAMOUNT BLVD
Practice Address - Street 2:406
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3331
Practice Address - Country:US
Practice Address - Phone:562-869-1070
Practice Address - Fax:562-869-6317
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2010-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA110335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine