Healthcare Provider Details

I. General information

NPI: 1053208058
Provider Name (Legal Business Name): SABRINA SULTANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 SCHOENFELD BLVD
PATCHOGUE NY
11772-2982
US

IV. Provider business mailing address

4168 S RIVER BASIN AVE
BOISE ID
83716-5819
US

V. Phone/Fax

Practice location:
  • Phone: 631-289-7700
  • Fax:
Mailing address:
  • Phone: 515-708-5330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP135894
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: