Basic Information
| Provider Information | |||||||||
| NPI: | 1700258308 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAIKH | ||||||||
| FirstName: | MOHSIN AHMED | ||||||||
| MiddleName: | MUKHTAR | ||||||||
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| Credential: | PH.D. CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1388 | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187040388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702888881 | ||||||||
| FaxNumber: | 5702888065 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 E. 2ND ST | ||||||||
| Address2: | CENTENNIAL HALL | ||||||||
| City: | BLOOMSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178151301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703895380 | ||||||||
| FaxNumber: | 5703895022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2015 | ||||||||
| LastUpdateDate: | 05/04/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AUD157 | HI | N | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | AT006491 | PA | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.