Provider Demographics
NPI:1356149298
Name:SHU AGHANIFOR, ISHMAEL
Entity type:Individual
Prefix:
First Name:ISHMAEL
Middle Name:
Last Name:SHU AGHANIFOR
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 1:3414 55TH AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1028
Mailing Address - Country:US
Mailing Address - Phone:202-826-0284
Mailing Address - Fax:
Practice Address - Street 1:3414 55TH AVE APT 301
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1028
Practice Address - Country:US
Practice Address - Phone:202-826-0284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171W00000XOther Service ProvidersContractor
No1744R1102XOther Service ProvidersSpecialistResearch Study
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner