Provider Demographics
NPI:1386953040
Name:QURAISHI, SHAHIDA (MSW INTERN)
Entity type:Individual
Prefix:
First Name:SHAHIDA
Middle Name:
Last Name:QURAISHI
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1514
Mailing Address - Country:US
Mailing Address - Phone:510-574-2084
Mailing Address - Fax:510-574-2054
Practice Address - Street 1:3300 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1514
Practice Address - Country:US
Practice Address - Phone:510-574-2084
Practice Address - Fax:510-574-2054
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
STUDENT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health