Provider Demographics
NPI:1932624731
Name:SADEKIN, SANJIDA
Entity type:Individual
Prefix:
First Name:SANJIDA
Middle Name:
Last Name:SADEKIN
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 1:37-11 35TH AVE SUITE 3C
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11101-8107
Mailing Address - Country:US
Mailing Address - Phone:718-706-7500
Mailing Address - Fax:
Practice Address - Street 1:3711 35TH AVE STE 3C
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11101-1441
Practice Address - Country:US
Practice Address - Phone:718-706-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty