Provider Demographics
NPI:1750777108
Name:SHABAZZ-COLON, SAWSAN
Entity type:Individual
Prefix:
First Name:SAWSAN
Middle Name:
Last Name:SHABAZZ-COLON
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 1:345 NEPONSET ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-1988
Mailing Address - Country:US
Mailing Address - Phone:781-633-7751
Mailing Address - Fax:
Practice Address - Street 1:345 NEPONSET ST STE 1
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-1988
Practice Address - Country:US
Practice Address - Phone:774-321-3913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2024-10-21
Deactivation Date:2022-03-23
Deactivation Code:
Reactivation Date:2022-06-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor