Healthcare Provider Details

I. General information

NPI: 1457150807
Provider Name (Legal Business Name): DR. SANYA AILANI
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NORTHERN BLVD STE 214
GREAT NECK NY
11021-5200
US

IV. Provider business mailing address

600 NORTHERN BLVD STE 214
GREAT NECK NY
11021-5200
US

V. Phone/Fax

Practice location:
  • Phone: 516-824-5369
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: