Healthcare Provider Details

I. General information

NPI: 1306702121
Provider Name (Legal Business Name): SANAM HAFEEZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2025
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 DAKOTA DR
NEW HYDE PARK NY
11042-1107
US

IV. Provider business mailing address

5 DAKOTA DR
NEW HYDE PARK NY
11042-1107
US

V. Phone/Fax

Practice location:
  • Phone: 914-439-7302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number011076
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: