Healthcare Provider Details

I. General information

NPI: 1891618005
Provider Name (Legal Business Name): SHAHARRIA GANTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 S WHITE HORSE PIKE
AUDUBON NJ
08106-1312
US

IV. Provider business mailing address

23 DOMAN AVE
WESTVILLE NJ
08093-1604
US

V. Phone/Fax

Practice location:
  • Phone: 609-535-2155
  • Fax:
Mailing address:
  • Phone: 609-553-2135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: