Healthcare Provider Details

I. General information

NPI: 1205730348
Provider Name (Legal Business Name): DIYANA SABAH AHMAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 ATLANTIC ST APT A
BRIDGEPORT CT
06604-5307
US

IV. Provider business mailing address

591 ATLANTIC ST APT A
BRIDGEPORT CT
06604-5307
US

V. Phone/Fax

Practice location:
  • Phone: 520-437-5687
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0017454
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: