Provider Demographics
NPI:1285224675
Name:IBIN NAEEM, SHAKIR TARIQ
Entity type:Individual
Prefix:
First Name:SHAKIR
Middle Name:TARIQ
Last Name:IBIN NAEEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9921 SW 162ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-3260
Mailing Address - Country:US
Mailing Address - Phone:305-319-0640
Mailing Address - Fax:
Practice Address - Street 1:10870 SW 113TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-3227
Practice Address - Country:US
Practice Address - Phone:305-846-9346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB616551106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician