Provider Demographics
NPI:1467052399
Name:BARR, KASIIM SHAKIR
Entity Type:Individual
Prefix:
First Name:KASIIM
Middle Name:SHAKIR
Last Name:BARR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4474 GOLDENRAIN CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-1771
Mailing Address - Country:US
Mailing Address - Phone:407-591-9502
Mailing Address - Fax:
Practice Address - Street 1:640 DR MARY MCLEOD BETHUNE BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-3012
Practice Address - Country:US
Practice Address - Phone:407-591-9502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling