Healthcare Provider Details

I. General information

NPI: 1164066767
Provider Name (Legal Business Name): SABAH SHAMSUDDIN ANGELES CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 06/30/2023
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 7TH AVE S
BIRMINGHAM AL
35233-1718
US

IV. Provider business mailing address

350 APPLEFORD RD
HELENA AL
35080-6808
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-8972
  • Fax: 205-975-9600
Mailing address:
  • Phone: 205-370-1319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-142623
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-142623
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: