Provider Demographics
NPI:1952092751
Name:SHABA, NADIA
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:SHABA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47300 PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-2551
Mailing Address - Country:US
Mailing Address - Phone:248-960-0352
Mailing Address - Fax:248-960-1861
Practice Address - Street 1:47300 PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-2551
Practice Address - Country:US
Practice Address - Phone:248-960-0352
Practice Address - Fax:248-960-1861
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303044852183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician