Provider Demographics
NPI:1609674365
Name:JHA, SHAMMY
Entity type:Individual
Prefix:
First Name:SHAMMY
Middle Name:
Last Name:JHA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5194 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-1825
Mailing Address - Country:US
Mailing Address - Phone:763-710-7296
Mailing Address - Fax:763-710-7475
Practice Address - Street 1:5194 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-1825
Practice Address - Country:US
Practice Address - Phone:763-710-7296
Practice Address - Fax:763-710-7475
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician