Provider Demographics
NPI:1518380211
Name:SHABAYA, JUDITH
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:SHABAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:SHABAYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3641 BERKELEY LN
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-1591
Mailing Address - Country:US
Mailing Address - Phone:330-204-7407
Mailing Address - Fax:
Practice Address - Street 1:3641 BERKELEY LN
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-1591
Practice Address - Country:US
Practice Address - Phone:330-204-7407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care