Provider Demographics
NPI:1750732442
Name:SULTANA, REBEKA
Entity type:Individual
Prefix:
First Name:REBEKA
Middle Name:
Last Name:SULTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2194 LONGFELLOW AVENUE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N9B3J6
Mailing Address - Country:CA
Mailing Address - Phone:309-256-6044
Mailing Address - Fax:
Practice Address - Street 1:2194 LONGFELLOW AVENUE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:ONTARIO
Practice Address - Zip Code:N9B3J6
Practice Address - Country:CA
Practice Address - Phone:309-256-6044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other