Healthcare Provider Details

I. General information

NPI: 1982530242
Provider Name (Legal Business Name): ASMAU AMATULLAH IMHOTEP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301A W PALMETTO PARK RD STE 100C
BOCA RATON FL
33433-3403
US

IV. Provider business mailing address

3701 NW 114TH LN
CORAL SPRINGS FL
33065-2625
US

V. Phone/Fax

Practice location:
  • Phone: 954-799-1684
  • Fax:
Mailing address:
  • Phone: 954-799-1684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: