MEDICARE: MISS SHADIYA A ABDALA I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)		OH

General Provider Information

NPI Number	:	1043799117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHADIYA A ABDALA I

Provider Business Mailing Address
First Line	:	4642 BELVEDERE PARK
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-6366
Country	:	US
Telephone Number	:	614-285-1124
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 GEORGESVILLE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-3615
Country	:	US
Telephone Number	:	614-285-1124
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2018
Last Update Date	:	08/09/2018

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