Healthcare Provider Details

I. General information

NPI: 1104026905
Provider Name (Legal Business Name): RAZIA SULTANA MD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4979 HARLEM RD
AMHERST NY
14226-2547
US

IV. Provider business mailing address

4979 HARLEM RD
AMHERST NY
14226-2547
US

V. Phone/Fax

Practice location:
  • Phone: 716-923-4380
  • Fax:
Mailing address:
  • Phone: 716-923-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number263357
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number67804
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number67804
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number67804
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code207UN0903X
TaxonomyIn Vivo & In Vitro Nuclear Medicine Physician
License Number67804
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number67804
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number67804
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: