Provider Demographics
NPI:1487269791
Name:ELSAYED, WAFFA S
Entity type:Individual
Prefix:
First Name:WAFFA
Middle Name:S
Last Name:ELSAYED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 PARKWOOD DR APT 13S
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2301
Mailing Address - Country:US
Mailing Address - Phone:732-697-8113
Mailing Address - Fax:
Practice Address - Street 1:2035 LINCOLN HWY STE 1150
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3351
Practice Address - Country:US
Practice Address - Phone:866-557-8669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSW-GTL-20-01159104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJZBYA40571006OtherLIABILITY INSURANCE