Provider Demographics
NPI:1558865790
Name:SABOORI, SHADAB (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:SHADAB
Middle Name:
Last Name:SABOORI
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 ROSEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2459
Mailing Address - Country:US
Mailing Address - Phone:404-421-7903
Mailing Address - Fax:
Practice Address - Street 1:155 FORE RIVER PKWY STE 1301
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2795
Practice Address - Country:US
Practice Address - Phone:207-535-1100
Practice Address - Fax:207-879-8787
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD27959207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology