Healthcare Provider Details

I. General information

NPI: 1174431316
Provider Name (Legal Business Name): AFNAN AHMED ALHADHARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 OLD NICHOLS RD
ISLANDIA NY
11749-5026
US

IV. Provider business mailing address

107 ROSARY AVE
BUFFALO NY
14218-1634
US

V. Phone/Fax

Practice location:
  • Phone: 631-828-4545
  • Fax:
Mailing address:
  • Phone: 716-393-7283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number033502
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: