Individual
EITHAR ELIAS SHABBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2200 RANDALLIA DR, FORT WAYNE, IN 46805-4638
(260) 373-7765
Mailing address
2200 RANDALLIA DR, FORT WAYNE, IN 46805-4638
(260) 373-7765
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
11024165A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2025
Last updated
07/04/2025
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