Provider Demographics
NPI:1689006090
Name:SHAHAB, AMJAD (CNIM)
Entity Type:Individual
Prefix:
First Name:AMJAD
Middle Name:
Last Name:SHAHAB
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BUCK TRAIL PL
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-8688
Mailing Address - Country:US
Mailing Address - Phone:832-547-0972
Mailing Address - Fax:713-581-6951
Practice Address - Street 1:16131 N ELDRIDGE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-9130
Practice Address - Country:US
Practice Address - Phone:281-970-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic