Provider Demographics
NPI:1134964067
Name:BAJWA, SHABANA AMER (FNP)
Entity type:Individual
Prefix:
First Name:SHABANA
Middle Name:AMER
Last Name:BAJWA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 CORNWELL DR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-3128
Mailing Address - Country:US
Mailing Address - Phone:302-222-8132
Mailing Address - Fax:
Practice Address - Street 1:TRI-STATE HEALTH INC
Practice Address - Street 2:266 S COLLEGE AVE
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711
Practice Address - Country:US
Practice Address - Phone:302-368-2563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0012805363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner