Provider Demographics
NPI:1174224315
Name:LAWAL, SAUDAT IYABODE (PMHNP)
Entity type:Individual
Prefix:
First Name:SAUDAT
Middle Name:IYABODE
Last Name:LAWAL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 FAIRYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-1921
Mailing Address - Country:US
Mailing Address - Phone:412-620-8218
Mailing Address - Fax:
Practice Address - Street 1:524 FAIRYWOOD ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-1921
Practice Address - Country:US
Practice Address - Phone:412-620-8218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027290363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health