Provider Demographics
NPI:1477364974
Name:ABDUL-LATEEF, NUSAYBAH
Entity type:Individual
Prefix:
First Name:NUSAYBAH
Middle Name:
Last Name:ABDUL-LATEEF
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 1:43511 REVERE DR
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-1673
Mailing Address - Country:US
Mailing Address - Phone:734-545-5593
Mailing Address - Fax:
Practice Address - Street 1:44560 FORD RD STE B
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2944
Practice Address - Country:US
Practice Address - Phone:734-680-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician