Healthcare Provider Details

I. General information

NPI: 1245625318
Provider Name (Legal Business Name): RAHEELA SULTAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2015
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 EVERGREEN DR STE 110
GLEN MILLS PA
19342-1053
US

IV. Provider business mailing address

600 EVERGREEN DR STE 110
GLEN MILLS PA
19342-1053
US

V. Phone/Fax

Practice location:
  • Phone: 610-892-3800
  • Fax: 484-468-1412
Mailing address:
  • Phone: 610-892-3800
  • Fax: 484-468-1412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD84768
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD471099
License Number StatePA

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: