Healthcare Provider Details

I. General information

NPI: 1134045651
Provider Name (Legal Business Name): MOHAMMED SUFIYAAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NASIB SUFIYAAN

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1178 BROADWAY FL 3
NEW YORK NY
10001-5666
US

IV. Provider business mailing address

3145 CRESCENT ST APT 14D
ASTORIA NY
11106-3745
US

V. Phone/Fax

Practice location:
  • Phone: 917-284-9393
  • Fax: 917-284-9393
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: