Provider Demographics
NPI:1821643545
Name:SHOBLE, OSMAN
Entity Type:Individual
Prefix:
First Name:OSMAN
Middle Name:
Last Name:SHOBLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 PARK ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-2728
Mailing Address - Country:US
Mailing Address - Phone:315-450-3138
Mailing Address - Fax:
Practice Address - Street 1:1000 PARK ST APT 1R
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-2728
Practice Address - Country:US
Practice Address - Phone:315-450-3138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker