Provider Demographics
NPI:1831587120
Name:ROBINSON, SADIYYAH
Entity type:Individual
Prefix:
First Name:SADIYYAH
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SADIYYAJ
Other - Middle Name:
Other - Last Name:SHABAZZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1201 RAVENNA ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6051
Mailing Address - Country:US
Mailing Address - Phone:817-478-3733
Mailing Address - Fax:
Practice Address - Street 1:1201 RAVENNA ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6051
Practice Address - Country:US
Practice Address - Phone:817-478-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX765017163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management