Provider Demographics
NPI:1518476472
Name:SHAFIQ, JAWEDULLAH
Entity type:Individual
Prefix:
First Name:JAWEDULLAH
Middle Name:
Last Name:SHAFIQ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13659 LEGACY CIR APT J
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4768
Mailing Address - Country:US
Mailing Address - Phone:703-537-9859
Mailing Address - Fax:
Practice Address - Street 1:7175 COLUMBIA GATEWAY DR STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2536
Practice Address - Country:US
Practice Address - Phone:703-537-9859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician