Provider Demographics
NPI:1316316904
Name:RABBANI, SHADI (MS, SLP INTERN)
Entity type:Individual
Prefix:
First Name:SHADI
Middle Name:
Last Name:RABBANI
Suffix:
Gender:F
Credentials:MS, SLP INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7002 LEBANON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-7461
Mailing Address - Country:US
Mailing Address - Phone:469-408-4634
Mailing Address - Fax:
Practice Address - Street 1:7002 LEBANON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7461
Practice Address - Country:US
Practice Address - Phone:469-408-4634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110984235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist