Healthcare Provider Details

I. General information

NPI: 1790617645
Provider Name (Legal Business Name): SHAMIKA SAMERA FOX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PINETOWN RD STE 430
FORT WASHINGTON PA
19034-2609
US

IV. Provider business mailing address

2093 PHILADELPHIA PIKE # 4870
CLAYMONT DE
19703-2424
US

V. Phone/Fax

Practice location:
  • Phone: 610-615-0531
  • Fax:
Mailing address:
  • Phone: 267-328-0499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: