Healthcare Provider Details

I. General information

NPI: 1881246387
Provider Name (Legal Business Name): SAMEERA SULTANA QURAISHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19316 US ROUTE 11
WATERTOWN NY
13601-6735
US

IV. Provider business mailing address

19316 US ROUTE 11
WATERTOWN NY
13601-6735
US

V. Phone/Fax

Practice location:
  • Phone: 315-782-0136
  • Fax:
Mailing address:
  • Phone: 315-782-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number338206
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: