Provider Demographics
NPI:1780385013
Name:JOHNSON, SURAYYAH
Entity type:Individual
Prefix:
First Name:SURAYYAH
Middle Name:
Last Name:JOHNSON
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 1:640 ATLANTIC AVE APT 347
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-7523
Mailing Address - Country:US
Mailing Address - Phone:609-992-7385
Mailing Address - Fax:
Practice Address - Street 1:640 ATLANTIC AVE APT 347
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-7523
Practice Address - Country:US
Practice Address - Phone:609-992-7385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty