Provider Demographics
NPI:1649066440
Name:ALSHABAN, ABDULLAH N I
Entity type:Individual
Prefix:MR
First Name:ABDULLAH
Middle Name:N
Last Name:ALSHABAN
Suffix:I
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 ROSLYN WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-6533
Mailing Address - Country:US
Mailing Address - Phone:916-621-7887
Mailing Address - Fax:
Practice Address - Street 1:1650 SILICA AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-3429
Practice Address - Country:US
Practice Address - Phone:916-621-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY2304542172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver