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General NPI Number Information
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NPI Number | 1558865790
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Entity Type | Individual
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Provider Name | SHADAB SABOORI MD, MPH
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Gender | Female
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 155 FORE RIVER PKWY STE 1301
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City | PORTLAND
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State | ME
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Zip | 04102-2795
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Country | US
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Telephone | 207-535-1100
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Fax | 207-879-8787
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Provider Business Mailing Address
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Address Line | 66 ROSEMONT AVE
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City | PORTLAND
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State | ME
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Zip | 04103-2459
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Country | US
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Telephone | 404-421-7903
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD27959
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License Number State | ME
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