Provider Demographics
NPI:1225521008
Name:SHAH REHMANNY, SULTAN (MD)
Entity Type:Individual
Prefix:
First Name:SULTAN
Middle Name:
Last Name:SHAH REHMANNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15790 PAUL VEGA DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1436
Mailing Address - Country:US
Mailing Address - Phone:708-629-9322
Mailing Address - Fax:985-230-6652
Practice Address - Street 1:15790 PAUL VEGA MD DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1436
Practice Address - Country:US
Practice Address - Phone:708-629-9322
Practice Address - Fax:985-230-6480
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LAMD.327925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA012489024OtherDRIVERS LICENSE