Provider Demographics
NPI:1760350201
Name:SAKILAH, AUGUSTINE T
Entity type:Individual
Prefix:
First Name:AUGUSTINE
Middle Name:T
Last Name:SAKILAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12347 W MEADOWBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4293
Mailing Address - Country:US
Mailing Address - Phone:602-475-2069
Mailing Address - Fax:
Practice Address - Street 1:1834 E BASELINE RD STE 101
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1508
Practice Address - Country:US
Practice Address - Phone:405-485-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician