Provider Demographics
NPI:1366208332
Name:HAIDARY, ABDUL SHUKOOR (MPH)
Entity type:Individual
Prefix:MR
First Name:ABDUL
Middle Name:SHUKOOR
Last Name:HAIDARY
Suffix:
Gender:M
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 W BROADWAY APT F223
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-2363
Mailing Address - Country:US
Mailing Address - Phone:657-702-0215
Mailing Address - Fax:
Practice Address - Street 1:2215 W BROADWAY APT F223
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-2363
Practice Address - Country:US
Practice Address - Phone:657-702-0215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker