Provider Demographics
NPI:1467717660
Name:MAHMUD, AMINU SUFU (LPN)
Entity Type:Individual
Prefix:
First Name:AMINU
Middle Name:SUFU
Last Name:MAHMUD
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3478 WILSON AVE APT 4D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-2366
Mailing Address - Country:US
Mailing Address - Phone:646-532-0603
Mailing Address - Fax:347-602-7996
Practice Address - Street 1:3478 WILSON AVE APT 4D
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-2366
Practice Address - Country:US
Practice Address - Phone:646-532-0603
Practice Address - Fax:347-602-7996
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308881164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY308881OtherTHE UNIVERSITY OF THE STATE OF NEW YORK EDUCATION DEPARTMENT