MEDICARE: SHAYNA ABIE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	36567	TX

General Provider Information

NPI Number	:	1679184519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAYNA ABIE

Provider Business Mailing Address
First Line	:	240 DESERT PASS ST APT 2101
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-3627
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6910 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-4445
Country	:	US
Telephone Number	:	915-995-5014
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2020
Last Update Date	:	08/13/2020

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Directions to “ SHAYNA ABIE ” Practice Location

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