Provider Demographics
NPI:1265251011
Name:MUSAHANOVA, SHAHZODA
Entity type:Individual
Prefix:
First Name:SHAHZODA
Middle Name:
Last Name:MUSAHANOVA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3628 MADISON AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-5070
Mailing Address - Country:US
Mailing Address - Phone:916-500-8155
Mailing Address - Fax:
Practice Address - Street 1:3628 MADISON AVE STE 6
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-5070
Practice Address - Country:US
Practice Address - Phone:916-500-8155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
CAASW1243111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No172V00000XOther Service ProvidersCommunity Health Worker