Provider Demographics
NPI:1700410610
Name:SANUSI, ABOLADE AKEEM
Entity Type:Individual
Prefix:
First Name:ABOLADE
Middle Name:AKEEM
Last Name:SANUSI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17592 W HADLEY ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-4030
Mailing Address - Country:US
Mailing Address - Phone:623-932-7888
Mailing Address - Fax:480-546-3574
Practice Address - Street 1:17592 W HADLEY ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-4030
Practice Address - Country:US
Practice Address - Phone:623-932-7888
Practice Address - Fax:480-546-3574
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst