Healthcare Provider Details

I. General information

NPI: 1700397437
Provider Name (Legal Business Name): ZAKIYYAH SULUKI CERTIFIED HAIR LOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 08/17/2025
Certification Date: 08/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 VANDENBURG RD APT 1124
KING OF PRUSSIA PA
19406-1566
US

IV. Provider business mailing address

701 E CATHEDRAL RD # 2232
PHILADELPHIA PA
19128-2128
US

V. Phone/Fax

Practice location:
  • Phone: 610-400-4688
  • Fax: 828-383-9667
Mailing address:
  • Phone: 610-400-4688
  • Fax: 828-383-9667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCT020639L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCT020639
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: