Provider Demographics
NPI:1033381579
Name:WASTY, SAADIA NAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:SAADIA
Middle Name:NAZ
Last Name:WASTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 SMITHTOWN BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1869
Mailing Address - Country:US
Mailing Address - Phone:631-292-0100
Mailing Address - Fax:
Practice Address - Street 1:195 SMITHTOWN BLVD STE 104
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1869
Practice Address - Country:US
Practice Address - Phone:631-292-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251904207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03788992Medicaid