Provider Demographics
NPI:1578454955
Name:SHABAZZ, RACHEL A
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:A
Last Name:SHABAZZ
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 1:1100 SLATEWORTH DR APT 1123
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6211
Mailing Address - Country:US
Mailing Address - Phone:804-898-9258
Mailing Address - Fax:
Practice Address - Street 1:127 NEW ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:VA
Practice Address - Zip Code:23890-5006
Practice Address - Country:US
Practice Address - Phone:804-898-9258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1261011229246Z00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other