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General NPI Number Information
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NPI Number | 1295680809
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Entity Type | Organization
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Legal Business Name | SANA KASUMOVIC PLLC
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Dates
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Enumeration Date | 02/27/2026
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Last Update Date | 02/27/2026
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Provider Practice Location Address
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Address Line | 2716 SYRINGA LN
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City | CALDWELL
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State | ID
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Zip | 83605-3052
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Country | US
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Telephone | 208-850-5111
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Fax |
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Provider Business Mailing Address
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Address Line | 3 MAKIN LN
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City | SUCCASUNNA
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State | NJ
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Zip | 07876-1111
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Country | US
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Telephone | 208-850-5111
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Fax |
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Authorized Official
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Title or Position | PA-C
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Name | SANDRA KASUMOVIC
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Credential | DMSC, MPAS
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Telephone | 208-850-5111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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