Provider Demographics
NPI:1316349293
Name:MINEGA SHABANI, AIME
Entity type:Individual
Prefix:
First Name:AIME
Middle Name:
Last Name:MINEGA SHABANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 7TH ST
Mailing Address - Street 2:UNIT 621
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-2245
Mailing Address - Country:US
Mailing Address - Phone:602-486-2173
Mailing Address - Fax:
Practice Address - Street 1:10 7TH ST
Practice Address - Street 2:UNIT 621
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-2245
Practice Address - Country:US
Practice Address - Phone:602-486-2173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY693298745172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver