Healthcare Provider Details

I. General information

NPI: 1497538672
Provider Name (Legal Business Name): MARYAM SARDAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HOSPITAL DR
UTICA NY
13502-2517
US

IV. Provider business mailing address

111 HOSPITAL DR
UTICA NY
13502-2517
US

V. Phone/Fax

Practice location:
  • Phone: 315-917-9966
  • Fax: 315-917-9966
Mailing address:
  • Phone: 315-917-9966
  • Fax: 315-917-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number346484
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: