Provider Demographics
NPI:1306668264
Name:SAMAD, BIBI FALEENA KHAN (NP)
Entity type:Individual
Prefix:MS
First Name:BIBI
Middle Name:FALEENA KHAN
Last Name:SAMAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19605 DUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1405
Mailing Address - Country:US
Mailing Address - Phone:929-253-7545
Mailing Address - Fax:
Practice Address - Street 1:19605 DUNTON AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-1405
Practice Address - Country:US
Practice Address - Phone:929-253-7545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF311342-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health