Healthcare Provider Details

I. General information

NPI: 1760278048
Provider Name (Legal Business Name): SOPHIA AWAD ATIFAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6451 SCHAEFER RD
DEARBORN MI
48126-2212
US

IV. Provider business mailing address

19445 W WARREN AVE
DETROIT MI
48228-3361
US

V. Phone/Fax

Practice location:
  • Phone: 313-945-8138
  • Fax: 313-203-3390
Mailing address:
  • Phone: 734-324-0055
  • Fax: 313-281-2235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704339547
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: