Healthcare Provider Details

I. General information

NPI: 1093909137
Provider Name (Legal Business Name): AYESHA SULTANA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W WILLIAMS ST SUITE 102, APEX MEDICAL PARK
APEX NC
27502-3978
US

IV. Provider business mailing address

5509 SOUTHERN CROSS AVE
RALEIGH NC
27606-4015
US

V. Phone/Fax

Practice location:
  • Phone: 919-300-7726
  • Fax: 919-300-7688
Mailing address:
  • Phone: 919-337-7350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2008-01657
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: