Provider Demographics
NPI:1134654304
Name:ALSUDANI, AYMAN A
Entity Type:Individual
Prefix:
First Name:AYMAN
Middle Name:A
Last Name:ALSUDANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AYMAN
Other - Middle Name:
Other - Last Name:MUSTAFA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5267 CAMERON CREEK PL
Mailing Address - Street 2:197
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4614
Mailing Address - Country:US
Mailing Address - Phone:817-423-9356
Mailing Address - Fax:
Practice Address - Street 1:5267 CAMERON CREEK PL
Practice Address - Street 2:197
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4614
Practice Address - Country:US
Practice Address - Phone:817-423-9356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)