MEDICARE: SUHAILA MUBASLAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1245804251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUHAILA MUBASLAT

Provider Business Mailing Address
First Line	:	7633 SOUTHERN BROOK BND
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-1815
Country	:	US
Telephone Number	:	267-270-7582
Fax Number	:

Provider Business Practice Location Address
First Line	:	1503 S US HIGHWAY 301 STE E16
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-5126
Country	:	US
Telephone Number	:	813-591-4868
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2021
Last Update Date	:	05/17/2021

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Directions to “ SUHAILA MUBASLAT ” Practice Location

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