Healthcare Provider Details

I. General information

NPI: 1861308835
Provider Name (Legal Business Name): SUMAIYA ALAM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10415 101ST AVE
OZONE PARK NY
11416-2702
US

IV. Provider business mailing address

3410 BROADWAY FL 2
NEW YORK NY
10031-7400
US

V. Phone/Fax

Practice location:
  • Phone: 718-441-0660
  • Fax: 646-360-2224
Mailing address:
  • Phone: 718-441-0660
  • Fax: 646-360-2224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number355964
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: