Provider Demographics
NPI:1275271603
Name:JABEEN, SUFIA (PA-C)
Entity Type:Individual
Prefix:
First Name:SUFIA
Middle Name:
Last Name:JABEEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 UNIVERSITY DR # 700
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3489
Mailing Address - Country:US
Mailing Address - Phone:919-237-1337
Mailing Address - Fax:919-237-1337
Practice Address - Street 1:10208 CERNY ST STE 104
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7885
Practice Address - Country:US
Practice Address - Phone:984-500-3165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2023-03-08
Deactivation Date:2023-01-28
Deactivation Code:
Reactivation Date:2023-03-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health