1578619334 NPI number — MS. SHELDA J ABDUR-RAZZAQ LPC

Table of content: MS. SHELDA J ABDUR-RAZZAQ LPC (NPI 1578619334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578619334 NPI number — MS. SHELDA J ABDUR-RAZZAQ LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABDUR-RAZZAQ
Provider First Name:
SHELDA
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578619334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5011 SOUTHPARK DR.
Provider Second Line Business Mailing Address:
5011 SOUTHPARK DR. SU. 130
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27713-6286
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-408-7839
Provider Business Mailing Address Fax Number:
919-361-1900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5011 SOUTHPARK DR.
Provider Second Line Business Practice Location Address:
5011 SOUTHPARK DR. SU. 130
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27713-6286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-408-7839
Provider Business Practice Location Address Fax Number:
919-361-1900
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  2126 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6102831 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 270858 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 10778 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 274221 . This is a "MHN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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