Healthcare Provider Details

I. General information

NPI: 1285574558
Provider Name (Legal Business Name): SANAIYA AHMED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5970 CHURCHVIEW DR
ROCKFORD IL
61107-2574
US

IV. Provider business mailing address

10460 MAYA LINDA RD APT F107
SAN DIEGO CA
92126-5266
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-8990
  • Fax: 815-971-9978
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: