Provider Demographics
NPI:1710589965
Name:SHABAZZ, FAREEDAH (LPN)
Entity Type:Individual
Prefix:
First Name:FAREEDAH
Middle Name:
Last Name:SHABAZZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1631
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28802-1631
Mailing Address - Country:US
Mailing Address - Phone:828-280-5089
Mailing Address - Fax:
Practice Address - Street 1:44 AURORA DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-1742
Practice Address - Country:US
Practice Address - Phone:828-280-5089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC83473164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse