Provider Demographics
NPI:1508749417
Name:IFTKHAR, SHAZIA (MSS)
Entity type:Individual
Prefix:
First Name:SHAZIA
Middle Name:
Last Name:IFTKHAR
Suffix:
Gender:F
Credentials:MSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 W GRAVERS LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3805
Mailing Address - Country:US
Mailing Address - Phone:608-335-3825
Mailing Address - Fax:
Practice Address - Street 1:21 S 11TH ST STE 216
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4223
Practice Address - Country:US
Practice Address - Phone:501-295-3728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1430121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical