Provider Demographics
NPI:1598269623
Name:SHABAZZ, SHAHEED MUSLIM
Entity Type:Individual
Prefix:
First Name:SHAHEED
Middle Name:MUSLIM
Last Name:SHABAZZ
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 1:208 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-3418
Mailing Address - Country:US
Mailing Address - Phone:609-532-2384
Mailing Address - Fax:609-771-0054
Practice Address - Street 1:208 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-3418
Practice Address - Country:US
Practice Address - Phone:609-532-2384
Practice Address - Fax:609-771-0054
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty