Provider Demographics
NPI:1326401001
Name:JAMIL, SADAF ALIYA
Entity type:Individual
Prefix:
First Name:SADAF
Middle Name:ALIYA
Last Name:JAMIL
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 1:1 E ROE BLVD
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2631
Mailing Address - Country:US
Mailing Address - Phone:631-475-3900
Mailing Address - Fax:631-475-5166
Practice Address - Street 1:645 E STATE HIGHWAY 121
Practice Address - Street 2:SUITE 600
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-7942
Practice Address - Country:US
Practice Address - Phone:972-745-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical