Healthcare Provider Details

I. General information

NPI: 1619577251
Provider Name (Legal Business Name): SHAKIRAH EWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 MORRIS TPKE
SHORT HILLS NJ
07078-2625
US

IV. Provider business mailing address

4075 LINGLESTOWN RD # 172
HARRISBURG PA
17112-1020
US

V. Phone/Fax

Practice location:
  • Phone: 323-205-7088
  • Fax: 833-419-0181
Mailing address:
  • Phone: 862-414-2214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00759900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC014624P
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: