Provider Demographics
NPI:1093362857
Name:MALIK, TAKEEMA SHLIESHA
Entity Type:Individual
Prefix:
First Name:TAKEEMA
Middle Name:SHLIESHA
Last Name:MALIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAKEIMA
Other - Middle Name:SHLIESHA
Other - Last Name:MALIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:87 E PADONIA RD APT 302
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2375
Mailing Address - Country:US
Mailing Address - Phone:443-409-2951
Mailing Address - Fax:
Practice Address - Street 1:414 LIGHT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-1251
Practice Address - Country:US
Practice Address - Phone:386-689-2112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty