Provider Demographics
NPI:1346504685
Name:KAMGA, SHARIFA TABITHA (MSPECED, MS PSYCH)
Entity Type:Individual
Prefix:MRS
First Name:SHARIFA
Middle Name:TABITHA
Last Name:KAMGA
Suffix:
Gender:F
Credentials:MSPECED, MS PSYCH
Other - Prefix:MISS
Other - First Name:SHARIFA
Other - Middle Name:TABITHA
Other - Last Name:WIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:624 E 220TH ST
Mailing Address - Street 2:APARTMENT 4H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-5345
Mailing Address - Country:US
Mailing Address - Phone:347-773-8299
Mailing Address - Fax:
Practice Address - Street 1:624 E 220TH ST
Practice Address - Street 2:APARTMENT 4H
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-5345
Practice Address - Country:US
Practice Address - Phone:347-773-8299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY894296174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist