Provider Demographics
NPI:1033691803
Name:ABDEL-JALEEL, ZAKIYYAH ABDEL-JALEEL
Entity Type:Individual
Prefix:
First Name:ZAKIYYAH
Middle Name:ABDEL-JALEEL
Last Name:ABDEL-JALEEL
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 1:8327 VOLUSIA PL
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-7914
Mailing Address - Country:US
Mailing Address - Phone:585-305-6607
Mailing Address - Fax:
Practice Address - Street 1:12 E EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1519
Practice Address - Country:US
Practice Address - Phone:585-305-6607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH22OtherRESTORATIVE SERVICES
OH22Medicaid