Provider Demographics
NPI:1609084664
Name:IJAZ, SADAF SULTANA (MBBS)
Entity Type:Individual
Prefix:DR
First Name:SADAF
Middle Name:SULTANA
Last Name:IJAZ
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:DR
Other - First Name:SADAF
Other - Middle Name:S
Other - Last Name:IJAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 E CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5493
Mailing Address - Country:US
Mailing Address - Phone:410-543-7119
Mailing Address - Fax:
Practice Address - Street 1:100 E CARROLL ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5493
Practice Address - Country:US
Practice Address - Phone:410-543-7119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1134182084P0800X
PAMD4402182084P0800X
NC1950172084P0800X
KYTP2262084P0800X
KY436752084P0800X
VA01012705362084P0800X
VA0116018182390200000X
MDD887522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025036920002Medicaid
NC1609084664Medicaid