Provider Demographics
NPI:1053336396
Name:MOHAMMAD, SYEDA YASMEEN (PSYDLP)
Entity type:Individual
Prefix:DR
First Name:SYEDA
Middle Name:YASMEEN
Last Name:MOHAMMAD
Suffix:
Gender:F
Credentials:PSYDLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6223 N CANTON CENTER RD
Mailing Address - Street 2:SUITE NUMBER 210
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2696
Mailing Address - Country:US
Mailing Address - Phone:734-737-1200
Mailing Address - Fax:734-737-1205
Practice Address - Street 1:6223 N CANTON CENTER RD
Practice Address - Street 2:SUITE NUMBER 210
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2696
Practice Address - Country:US
Practice Address - Phone:734-737-1200
Practice Address - Fax:734-737-1205
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI63-01-009113103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM02580007Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION #