Provider Demographics
NPI:1700258308
Name:SHAIKH, MOHSIN AHMED MUKHTAR (PHD CCC-A)
Entity Type:Individual
Prefix:
First Name:MOHSIN AHMED
Middle Name:MUKHTAR
Last Name:SHAIKH
Suffix:
Gender:M
Credentials:PHD CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1388
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0388
Mailing Address - Country:US
Mailing Address - Phone:570-288-8881
Mailing Address - Fax:570-288-8065
Practice Address - Street 1:400 E. 2ND ST
Practice Address - Street 2:CENTENNIAL HALL
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1301
Practice Address - Country:US
Practice Address - Phone:570-389-5380
Practice Address - Fax:570-389-5022
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAUD157231H00000X
PAAT006491231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist