Provider Demographics
NPI:1245804251
Name:MUBASLAT, SUHAILA
Entity Type:Individual
Prefix:
First Name:SUHAILA
Middle Name:
Last Name:MUBASLAT
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 1:7633 SOUTHERN BROOK BND
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-1815
Mailing Address - Country:US
Mailing Address - Phone:267-270-7582
Mailing Address - Fax:
Practice Address - Street 1:1503 S US HIGHWAY 301 STE E16
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-5126
Practice Address - Country:US
Practice Address - Phone:813-591-4868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical