Provider Demographics
NPI:1407579535
Name:GAFUR, SARA SULTANA (RN)
Entity Type:Individual
Prefix:MISS
First Name:SARA
Middle Name:SULTANA
Last Name:GAFUR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:SARA
Other - Middle Name:SULTANA
Other - Last Name:GAFUR-RIVAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:10906 164TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-2922
Mailing Address - Country:US
Mailing Address - Phone:347-601-1467
Mailing Address - Fax:
Practice Address - Street 1:16105 119TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-2137
Practice Address - Country:US
Practice Address - Phone:917-693-1947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY852147-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYUNKNOWNMedicaid