Healthcare Provider Details

I. General information

NPI: 1326401001
Provider Name (Legal Business Name): SADAF ALIYA JAMIL RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 MONTAUK HWY
SHIRLEY NY
11967-2114
US

IV. Provider business mailing address

PO BOX 5036
WHITE PLAINS NY
10602-5036
US

V. Phone/Fax

Practice location:
  • Phone: 631-490-3040
  • Fax: 631-490-3055
Mailing address:
  • Phone: 914-898-9421
  • Fax: 914-734-8786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number021675
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: