Healthcare Provider Details

I. General information

NPI: 1619339215
Provider Name (Legal Business Name): NAYELAH SULTAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

PO BOX 103204
GAINESVILLE FL
32610-0001
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-2200
  • Fax:
Mailing address:
  • Phone: 352-265-0651
  • Fax: 352-265-0153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME157094
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD464745
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME157094
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD464745
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: