Provider Demographics
NPI:1437703105
Name:BROOKS-SALAMI, AYISATU
Entity Type:Individual
Prefix:
First Name:AYISATU
Middle Name:
Last Name:BROOKS-SALAMI
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 1:176 CHAMBERLAIN DR
Mailing Address - Street 2:
Mailing Address - City:FATE
Mailing Address - State:TX
Mailing Address - Zip Code:75189-4915
Mailing Address - Country:US
Mailing Address - Phone:347-330-3066
Mailing Address - Fax:
Practice Address - Street 1:176 CHAMBERLAIN DR
Practice Address - Street 2:
Practice Address - City:FATE
Practice Address - State:TX
Practice Address - Zip Code:75189-4915
Practice Address - Country:US
Practice Address - Phone:347-330-3066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141741363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty