Provider Demographics
NPI:1982192217
Name:SHABAN, DANNY HICHAM (DO)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:HICHAM
Last Name:SHABAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 NUTT ST, APT 509
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401
Mailing Address - Country:US
Mailing Address - Phone:804-869-6664
Mailing Address - Fax:
Practice Address - Street 1:1705 GARDNER RD
Practice Address - Street 2:
Practice Address - City:WILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405
Practice Address - Country:US
Practice Address - Phone:910-343-5300
Practice Address - Fax:844-531-7818
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-017842084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry