Provider Demographics
NPI:1972712750
Name:SHAHEB, SUDAH
Entity Type:Individual
Prefix:
First Name:SUDAH
Middle Name:
Last Name:SHAHEB
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:P.O. BOX 706 HWY 77/75
Mailing Address - Street 2:WINNEBAGO TRIBE OF NEBRASKA
Mailing Address - City:WINNEBAGO
Mailing Address - State:NE
Mailing Address - Zip Code:68071-0706
Mailing Address - Country:US
Mailing Address - Phone:402-878-2440
Mailing Address - Fax:402-878-2831
Practice Address - Street 1:100 INDIAN DRIVE
Practice Address - Street 2:
Practice Address - City:MACY
Practice Address - State:NE
Practice Address - Zip Code:68039
Practice Address - Country:US
Practice Address - Phone:402-878-2440
Practice Address - Fax:402-878-2831
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21038207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism