Provider Demographics
NPI:1295014744
Name:FROTHINGHAM, SHAZIA MULKANA (PHD)
Entity type:Individual
Prefix:DR
First Name:SHAZIA
Middle Name:MULKANA
Last Name:FROTHINGHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 APPLERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8245
Mailing Address - Country:US
Mailing Address - Phone:601-829-0668
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 51/PSYCHOLOGICAL SERVICES
Practice Address - Street 2:MISSISSIPPI STATE HOSPITAL
Practice Address - City:WHITFIELD
Practice Address - State:MS
Practice Address - Zip Code:39193
Practice Address - Country:US
Practice Address - Phone:601-351-8475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS47-820103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical