Provider Demographics
NPI:1053208058
Name:SULTANA, SABRINA
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:SULTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4168 S RIVER BASIN AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-5819
Mailing Address - Country:US
Mailing Address - Phone:515-708-5330
Mailing Address - Fax:
Practice Address - Street 1:25 SCHOENFELD BLVD
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2982
Practice Address - Country:US
Practice Address - Phone:631-289-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP135894390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program