Provider Demographics
NPI:1730676875
Name:SHALABY, ABBY GAIL GAIL
Entity Type:Individual
Prefix:
First Name:ABBY GAIL
Middle Name:GAIL
Last Name:SHALABY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 VALDEZ ST APT 345
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3195
Mailing Address - Country:US
Mailing Address - Phone:628-444-8975
Mailing Address - Fax:
Practice Address - Street 1:170 EL CERRITO PLZ
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-4002
Practice Address - Country:US
Practice Address - Phone:628-444-8975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-14
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1034591223G0001X
WADR60854921204E00000X
390200000X
GADN1225841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program