Provider Demographics
NPI:1558627810
Name:SULTANA, SANJEDA (MD)
Entity Type:Individual
Prefix:
First Name:SANJEDA
Middle Name:
Last Name:SULTANA
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 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:984-215-4110
Mailing Address - Fax:
Practice Address - Street 1:6715 MCCRIMMON PKWY STE 300
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-1916
Practice Address - Country:US
Practice Address - Phone:919-481-4997
Practice Address - Fax:919-388-3271
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-01669207RE0101X
LAMD.208061207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19W25OtherBCBS OF NC
NCNN22770322OtherMEDICARE
NC1558627810Medicaid