Provider Demographics
NPI:1093172769
Name:MUJAHID, NAFEESAH
Entity Type:Individual
Prefix:
First Name:NAFEESAH
Middle Name:
Last Name:MUJAHID
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 1:3088 HARPERS FERRY DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-9407
Mailing Address - Country:US
Mailing Address - Phone:850-322-6064
Mailing Address - Fax:
Practice Address - Street 1:709 MILLARD ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-7037
Practice Address - Country:US
Practice Address - Phone:850-322-6064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities