Provider Demographics
NPI:1982069373
Name:SHAKEEBAI, SANNA
Entity Type:Individual
Prefix:
First Name:SANNA
Middle Name:
Last Name:SHAKEEBAI
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 1:11200 SEAN HAGGERTY DR APT 12203
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3388
Mailing Address - Country:US
Mailing Address - Phone:214-603-6977
Mailing Address - Fax:
Practice Address - Street 1:10600 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-1221
Practice Address - Country:US
Practice Address - Phone:915-591-4655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56401183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist