Provider Demographics
NPI:1467717660
Name:MAHMUD, AMINU SUFU (PMHNP)
Entity type:Individual
Prefix:
First Name:AMINU
Middle Name:SUFU
Last Name:MAHMUD
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13303 REDWOOD TRAIL LN
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-0436
Mailing Address - Country:US
Mailing Address - Phone:346-219-7516
Mailing Address - Fax:
Practice Address - Street 1:13303 REDWOOD TRAIL LN
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-0436
Practice Address - Country:US
Practice Address - Phone:346-219-7516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2025-04-08
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