Provider Demographics
NPI:1316441413
Name:MAHMOOD, SYEDA SUMAIYAH
Entity type:Individual
Prefix:
First Name:SYEDA SUMAIYAH
Middle Name:
Last Name:MAHMOOD
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 1:30903 W 10 MILE RD STE B
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2615
Mailing Address - Country:US
Mailing Address - Phone:248-893-6192
Mailing Address - Fax:248-457-5490
Practice Address - Street 1:30903 W 10 MILE RD STE B
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2615
Practice Address - Country:US
Practice Address - Phone:248-893-6192
Practice Address - Fax:248-457-5490
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010007225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist