Provider Demographics
NPI:1730505025
Name:MOORE-SHABAZZ, SHANNON (DOULA/BIRTH WORKER)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MOORE-SHABAZZ
Suffix:
Gender:F
Credentials:DOULA/BIRTH WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28667
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-0667
Mailing Address - Country:US
Mailing Address - Phone:267-471-8648
Mailing Address - Fax:
Practice Address - Street 1:6313 N FAIRHILL ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126-3846
Practice Address - Country:US
Practice Address - Phone:267-471-8648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No1744G0900XOther Service ProvidersSpecialistGraphics Designer