Healthcare Provider Details

I. General information

NPI: 1639873698
Provider Name (Legal Business Name): SANA SHAHZAD MEMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 VERSAILLES BLVD STE A
ALEXANDRIA LA
71303-3979
US

IV. Provider business mailing address

1000 E MOUNTAIN BLVD
WILKES BARRE PA
18711-0001
US

V. Phone/Fax

Practice location:
  • Phone: 318-442-2232
  • Fax: 318-442-9940
Mailing address:
  • Phone: 570-817-3588
  • Fax: 570-808-5967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number354352
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: