Healthcare Provider Details

I. General information

NPI: 1376344366
Provider Name (Legal Business Name): SUMAYA ABDUL GHAFFAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 S GRAND BLVD
SAINT LOUIS MO
63104-1004
US

IV. Provider business mailing address

13021 E 21ST AVE APT B251
AURORA CO
80045-7454
US

V. Phone/Fax

Practice location:
  • Phone: 314-617-3811
  • Fax:
Mailing address:
  • Phone: 913-444-1897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number99999999
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: