Provider Demographics
NPI:1134081698
Name:JONES COOK, SALAHUDEEN Y
Entity type:Individual
Prefix:
First Name:SALAHUDEEN
Middle Name:Y
Last Name:JONES COOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4518 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-4279
Mailing Address - Country:US
Mailing Address - Phone:602-503-6350
Mailing Address - Fax:
Practice Address - Street 1:4518 W PARK ST
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-4279
Practice Address - Country:US
Practice Address - Phone:602-503-6350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-02
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ233058363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty