Provider Demographics
NPI:1235952706
Name:DIAB, SHUROUQ
Entity type:Individual
Prefix:
First Name:SHUROUQ
Middle Name:
Last Name:DIAB
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 1:8248 STATE ROUTE 44
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-9782
Mailing Address - Country:US
Mailing Address - Phone:330-810-5886
Mailing Address - Fax:
Practice Address - Street 1:8248 STATE ROUTE 44
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-9782
Practice Address - Country:US
Practice Address - Phone:330-810-5886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver