Provider Demographics
NPI:1598451015
Name:NANGA MAKABU, SHERLOU
Entity Type:Individual
Prefix:
First Name:SHERLOU
Middle Name:
Last Name:NANGA MAKABU
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 1:2220 W MISSION LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2832
Mailing Address - Country:US
Mailing Address - Phone:602-459-4361
Mailing Address - Fax:
Practice Address - Street 1:2400 W DUNLAP AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2817
Practice Address - Country:US
Practice Address - Phone:602-661-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician