Provider Demographics
NPI:1992319537
Name:SHAHABUDDIN, NISHAT ANBAR (DMD)
Entity type:Individual
Prefix:
First Name:NISHAT
Middle Name:ANBAR
Last Name:SHAHABUDDIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W 48TH ST APT 26A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-1385
Mailing Address - Country:US
Mailing Address - Phone:917-757-0981
Mailing Address - Fax:
Practice Address - Street 1:3123 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-2378
Practice Address - Country:US
Practice Address - Phone:201-662-0662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI028112031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics