Provider Demographics
NPI:1215382163
Name:SHABAZZ, NAZIRAH JAMEELAH
Entity Type:Individual
Prefix:MS
First Name:NAZIRAH
Middle Name:JAMEELAH
Last Name:SHABAZZ
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 1:400 SAINT NICHOLAS AVE
Mailing Address - Street 2:APT#8 N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-7620
Mailing Address - Country:US
Mailing Address - Phone:917-674-6679
Mailing Address - Fax:
Practice Address - Street 1:400 ST. NICHOLAS AVE
Practice Address - Street 2:APT#8 N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027
Practice Address - Country:US
Practice Address - Phone:917-674-6679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2288994103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst