Provider Demographics
NPI:1740865245
Name:ABDULLAH, MUSTAFAA
Entity type:Individual
Prefix:
First Name:MUSTAFAA
Middle Name:
Last Name:ABDULLAH
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 1:903 OLD WARRIOR RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-1863
Mailing Address - Country:US
Mailing Address - Phone:205-222-4681
Mailing Address - Fax:
Practice Address - Street 1:903 OLD WARRIOR RIVER RD
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-1863
Practice Address - Country:US
Practice Address - Phone:205-222-4681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide