Healthcare Provider Details

I. General information

NPI: 1932820909
Provider Name (Legal Business Name): SULTANA'S MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 WEHRLE DR
BUFFALO NY
14221-7386
US

IV. Provider business mailing address

6319 EVERWOOD CT S
EAST AMHERST NY
14051-2031
US

V. Phone/Fax

Practice location:
  • Phone: 716-908-6374
  • Fax:
Mailing address:
  • Phone: 425-772-5172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SYED HAIDER
Title or Position: MANAGER
Credential: PHD
Phone: 425-772-5172