Healthcare Provider Details

I. General information

NPI: 1184372047
Provider Name (Legal Business Name): SHABANA ABDULLAH ABDULQADIR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MERCY AVE STE 400
MERCED CA
95340-8368
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 209-564-3700
  • Fax: 209-564-3799
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95020230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: