Provider Demographics
NPI:1336612266
Name:SHAHIDULLAH, JEFFREY DUKE (PHD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DUKE
Last Name:SHAHIDULLAH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 FRELINGHUYSEN RD OFC A353
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-8020
Mailing Address - Country:US
Mailing Address - Phone:848-445-3981
Mailing Address - Fax:
Practice Address - Street 1:152 FRELINGHUYSEN RD OFC A353
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-8020
Practice Address - Country:US
Practice Address - Phone:848-445-3981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018495103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical