Provider Demographics
NPI:1669156816
Name:SHEHADEH, IBRAHIM
Entity type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:
Last Name:SHEHADEH
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 1:5228 DILLON CIR
Mailing Address - Street 2:
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76137-5508
Mailing Address - Country:US
Mailing Address - Phone:317-499-8298
Mailing Address - Fax:
Practice Address - Street 1:5228 DILLON CIR
Practice Address - Street 2:
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76137-5508
Practice Address - Country:US
Practice Address - Phone:317-499-8298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48371984347C00000X, 342000000X, 172A00000X, 347C00000X, 347E00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Yes347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty
No342000000XTransportation ServicesTransportation Network Company
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No347E00000XTransportation ServicesTransportation Broker