Provider Demographics
NPI:1427369420
Name:SULLEY, ADIZA JUMAIH (MD)
Entity Type:Individual
Prefix:DR
First Name:ADIZA
Middle Name:JUMAIH
Last Name:SULLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ADIZA
Other - Middle Name:JUMAIH
Other - Last Name:MOHAMMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3640 W OSBORN RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019-4006
Mailing Address - Country:US
Mailing Address - Phone:602-269-5300
Mailing Address - Fax:602-269-5380
Practice Address - Street 1:3640 W OSBORN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019-4006
Practice Address - Country:US
Practice Address - Phone:602-269-5300
Practice Address - Fax:602-269-5380
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ489822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry