Provider Demographics
NPI:1255016085
Name:WAHEED, MONA (IBCLC)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:WAHEED
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7038 N VIA DE LA CAMPANA
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3903
Mailing Address - Country:US
Mailing Address - Phone:702-232-5536
Mailing Address - Fax:
Practice Address - Street 1:7038 N VIA DE LA CAMPANA
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3903
Practice Address - Country:US
Practice Address - Phone:702-232-5536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL-302107174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN