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General NPI Number Information
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NPI Number | 1508749417
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Entity Type | Individual
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Provider Name | SHAZIA IFTKHAR MSS
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Gender | Female
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 21 S 11TH ST STE 216
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4223
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Country | US
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Telephone | 501-295-3728
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Fax |
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Provider Business Mailing Address
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Address Line | 141 W GRAVERS LN
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City | PHILADELPHIA
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State | PA
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Zip | 19118-3805
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Country | US
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Telephone | 608-335-3825
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW143012
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License Number State | PA
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