Shimara Watson

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Practice address

76 Sisters Farmstead Dr
Mount Laurel, NJ 08054-1448

Phone

(347) 458-5494

NPI assigned

Jan 15, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dear Jaffa LLC

  • Community/Behavioral Health Agency
  • Mount Laurel, NJ
  • NPI 1790546901
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1705276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705276800000",
    "number": "1104697440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 FELLOWSHIP RD, EAST GATE CENTER",
            "address_2": "200",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080541448",
            "telephone_number": "347-458-5494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76 SISTERS FARMSTEAD DR",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080541448",
            "telephone_number": "347-458-5494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "SHIMARA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-15",
        "last_updated": "2024-01-15",
        "certification_date": "2024-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NJ",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Walter, RPH
• Yize Richard Wang, M.D.
• Breda C Ward, OTR/L
• Amanda I Wardwell
• Ronald M Warren, MD
• Nathan Paul Watters, M.D.
• Barbra M Webb, CF-SLP
• Marisa Latanya Wedderburn
• Wegmans Food Markets, Inc.
• Lisa Weissbach-Efrat, LSW

• Community/Behavioral Health Agency in Mount Laurel, NJ
• Providers in Mount Laurel, NJ by specialty
• Community/Behavioral Health Agency in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.