Provider Demographics
NPI:1730987579
Name:PRESIDENT, MIJANOU SHAKIRA
Entity type:Individual
Prefix:
First Name:MIJANOU
Middle Name:SHAKIRA
Last Name:PRESIDENT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-2244
Mailing Address - Country:US
Mailing Address - Phone:347-470-8009
Mailing Address - Fax:
Practice Address - Street 1:324 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-2244
Practice Address - Country:US
Practice Address - Phone:347-470-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula