Provider Demographics
NPI:1316786965
Name:SULTANA, JAKIA
Entity type:Individual
Prefix:
First Name:JAKIA
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 1:1629 GENESEE ST APT NOB-10
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-4747
Mailing Address - Country:US
Mailing Address - Phone:786-710-5253
Mailing Address - Fax:
Practice Address - Street 1:1657 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5415
Practice Address - Country:US
Practice Address - Phone:315-797-7392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP128235207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine