Healthcare Provider Details

I. General information

NPI: 1841826013
Provider Name (Legal Business Name): CHASITY SHAMEEL FABIYI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CENTURY AVE STE B
BISMARCK ND
58503-4900
US

IV. Provider business mailing address

300 W CENTURY AVE STE B
BISMARCK ND
58503-4900
US

V. Phone/Fax

Practice location:
  • Phone: 701-663-5373
  • Fax: 701-663-8556
Mailing address:
  • Phone: 701-663-5373
  • Fax: 701-663-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number981607
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: