Provider Demographics
NPI:1124890199
Name:ABDULLAHI, SHAKIRAT
Entity type:Individual
Prefix:
First Name:SHAKIRAT
Middle Name:
Last Name:ABDULLAHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16830 KINGSBURY ST APT 127
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6465
Mailing Address - Country:US
Mailing Address - Phone:323-378-0784
Mailing Address - Fax:
Practice Address - Street 1:17028 DEVONSHIRE ST
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-1617
Practice Address - Country:US
Practice Address - Phone:323-378-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY4991340343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)