MEDICARE: ASMAU AMATULLAH IMHOTEP

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	103TC2200X	Clinical Child & Adolescent Psychologist

General Provider Information

NPI Number	:	1982530242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASMAU AMATULLAH IMHOTEP

Provider Business Mailing Address
First Line	:	3701 NW 114TH LN
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-2625
Country	:	US
Telephone Number	:	954-799-1684
Fax Number	:

Provider Business Practice Location Address
First Line	:	7301A W PALMETTO PARK RD STE 100C
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3403
Country	:	US
Telephone Number	:	954-799-1684
Fax Number	:

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

Provider Enumeration Date	:	06/23/2026
Last Update Date	:	06/23/2026

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