Healthcare Provider Details

I. General information

NPI: 1013824523
Provider Name (Legal Business Name): SHAHD FAROG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 S 14TH ST APT B1
LINCOLN NE
68502-3601
US

IV. Provider business mailing address

2301 S 14TH ST APT B1
LINCOLN NE
68502-3601
US

V. Phone/Fax

Practice location:
  • Phone: 402-450-6551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: