Healthcare Provider Details

I. General information

NPI: 1134034325
Provider Name (Legal Business Name): AMENEH ZARE SHAHABADI MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 JASMINE DR APT E
KENT OH
44240-8608
US

IV. Provider business mailing address

8050 E HIGHWAY 191 STE 205
ODESSA TX
79765-8615
US

V. Phone/Fax

Practice location:
  • Phone: 432-703-3936
  • Fax:
Mailing address:
  • Phone: 432-703-3936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: AMENEH SHAHABADI
Title or Position: OWNER
Credential:
Phone: 432-703-3936