Provider Demographics
NPI:1780807610
Name:HAFEEZ, SANAM (PSYD)
Entity type:Individual
Prefix:DR
First Name:SANAM
Middle Name:
Last Name:HAFEEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8460 123RD ST
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3305
Mailing Address - Country:US
Mailing Address - Phone:718-441-0166
Mailing Address - Fax:718-805-2054
Practice Address - Street 1:8460 123RD ST
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-3305
Practice Address - Country:US
Practice Address - Phone:718-441-0166
Practice Address - Fax:718-805-2054
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68-016117103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist