Shariffah Chuma Azzaam

Individual provider Active NPI Behavior Analyst · Philadelphia, PA

NPI 1396360459 · NPPES record last updated Jun 14, 2020

Key facts

NPI
1396360459
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Analyst 103K00000X
License
1-18-29537 (ZZ)
Practice address
5862 N 6TH St
Philadelphia, PA 19120-1303
Phone
(302) 307-1663
NPI assigned
Jun 14, 2020
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Community Behavior Analytics Behavior Analyst Current
since Jun 28, 2020
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst
Group: 193400000X SINGLE SPECIALTY GROUP
103K00000X 1-18-29537 ZZ Yes

Addresses

Primary practice location

5862 N 6TH St
Philadelphia, PA 19120-1303

Mailing address

5862 N 6TH St
Philadelphia, PA 19120-1303

Other providers in Philadelphia, PA

All providers in Philadelphia, PA · Behavior Analyst in Pennsylvania

Sources for this page

Verify at the official NPI Registry.