Provider Demographics
NPI:1639946015
Name:MARSHAM, MYASIA SHAKIRA
Entity type:Individual
Prefix:
First Name:MYASIA
Middle Name:SHAKIRA
Last Name:MARSHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MERRELL AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3649
Mailing Address - Country:US
Mailing Address - Phone:914-582-4162
Mailing Address - Fax:
Practice Address - Street 1:157 CHURCH ST FL 19
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2100
Practice Address - Country:US
Practice Address - Phone:732-204-1635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician