Provider Demographics
NPI:1376398032
Name:SHABRAM, ISAIAH G
Entity type:Individual
Prefix:MR
First Name:ISAIAH
Middle Name:G
Last Name:SHABRAM
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 1:87342 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-4651
Mailing Address - Country:US
Mailing Address - Phone:402-340-5222
Mailing Address - Fax:
Practice Address - Street 1:1800 W PASEWALK AVE STE A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5657
Practice Address - Country:US
Practice Address - Phone:402-500-6870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator