Provider Demographics
NPI:1952155251
Name:ABDELSHAFY, WALEED
Entity Type:Individual
Prefix:MR
First Name:WALEED
Middle Name:
Last Name:ABDELSHAFY
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 1:2806 GRANADA CIR W
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-6204
Mailing Address - Country:US
Mailing Address - Phone:502-314-0787
Mailing Address - Fax:
Practice Address - Street 1:2806 GRANADA CIR W
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-6204
Practice Address - Country:US
Practice Address - Phone:502-314-0787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN5400049088172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver