Provider Demographics
NPI:1730243577
Name:SHADI, ABY (DC)
Entity type:Individual
Prefix:DR
First Name:ABY
Middle Name:
Last Name:SHADI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1014
Mailing Address - Country:US
Mailing Address - Phone:718-441-4070
Mailing Address - Fax:781-441-4027
Practice Address - Street 1:9525 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2268
Practice Address - Country:US
Practice Address - Phone:718-441-4070
Practice Address - Fax:718-441-4027
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009682-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV06117Medicare UPIN