Provider Demographics
NPI:1336345255
Name:MOUSTAFA, SHAKA ABDUL I (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHAKA
Middle Name:ABDUL
Last Name:MOUSTAFA
Suffix:I
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CAUGHMAN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-3114
Mailing Address - Country:US
Mailing Address - Phone:803-477-7928
Mailing Address - Fax:
Practice Address - Street 1:108 CAUGHMAN RIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-3114
Practice Address - Country:US
Practice Address - Phone:803-477-7928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional