Provider Demographics
NPI:1740623461
Name:SHABEZ, EDWARD ODESHOO (NMD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ODESHOO
Last Name:SHABEZ
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 S 162ND LN
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-3544
Mailing Address - Country:US
Mailing Address - Phone:623-377-1674
Mailing Address - Fax:
Practice Address - Street 1:8550 E SHEA BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6678
Practice Address - Country:US
Practice Address - Phone:480-625-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ09-1104175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath