MEDICARE: DIYA SHABAZZ

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1114885464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIYA SHABAZZ

Provider Business Mailing Address
First Line	:	15277 TRISKETT RD APT 2
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3055
Country	:	US
Telephone Number	:	216-264-8143
Fax Number	:

Provider Business Practice Location Address
First Line	:	15277 TRISKETT RD APT 2
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3055
Country	:	US
Telephone Number	:	216-264-8143
Fax Number	:

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

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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Directions to “ DIYA SHABAZZ ” Practice Location

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