Provider Demographics
NPI:1528353307
Name:MUHAMMAD, WALI SHAREEF (MBA)
Entity type:Individual
Prefix:MR
First Name:WALI
Middle Name:SHAREEF
Last Name:MUHAMMAD
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 HUNT LN
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-1104
Mailing Address - Country:US
Mailing Address - Phone:203-936-9254
Mailing Address - Fax:203-823-4470
Practice Address - Street 1:15 HOSLEY AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2523
Practice Address - Country:US
Practice Address - Phone:203-936-9254
Practice Address - Fax:203-823-4470
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008030395Medicaid