Provider Demographics
NPI:1760291066
Name:TENKAWUR, SHEMZHERU JAM
Entity type:Individual
Prefix:
First Name:SHEMZHERU
Middle Name:JAM
Last Name:TENKAWUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JUSTIN
Other - Middle Name:ADAM MICHAEL
Other - Last Name:FORREST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4804 WILLISTON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-4311
Mailing Address - Country:US
Mailing Address - Phone:443-902-7285
Mailing Address - Fax:
Practice Address - Street 1:4804 WILLISTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4311
Practice Address - Country:US
Practice Address - Phone:443-902-7285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician