Provider Demographics
NPI:1790558245
Name:SHABAZZ, NAADIYAH
Entity Type:Individual
Prefix:
First Name:NAADIYAH
Middle Name:
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 1:3420 SEPTEMBER MORN
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-3650
Mailing Address - Country:US
Mailing Address - Phone:951-796-0760
Mailing Address - Fax:
Practice Address - Street 1:3420 SEPTEMBER MORN
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-3650
Practice Address - Country:US
Practice Address - Phone:951-796-0760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician