Provider Demographics
NPI:1356941967
Name:ABDULAAIMA, SHAHAD
Entity type:Individual
Prefix:
First Name:SHAHAD
Middle Name:
Last Name:ABDULAAIMA
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 1:4058 LAAR CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3252
Mailing Address - Country:US
Mailing Address - Phone:804-503-0025
Mailing Address - Fax:
Practice Address - Street 1:1400 7TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3387
Practice Address - Country:US
Practice Address - Phone:804-503-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202216489183500000X
DCPH100003477183500000X
MD26381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist