Provider Demographics
NPI:1265168652
Name:SULTANA, NAZIFA (AU D)
Entity type:Individual
Prefix:
First Name:NAZIFA
Middle Name:
Last Name:SULTANA
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 LINE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2126
Mailing Address - Country:US
Mailing Address - Phone:318-629-4681
Mailing Address - Fax:318-425-3236
Practice Address - Street 1:2121 LINE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2126
Practice Address - Country:US
Practice Address - Phone:318-629-4681
Practice Address - Fax:318-425-3236
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9150231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist