Basic Information
| Provider Information | |||||||||
| NPI: | 1588044044 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHONDKER | ||||||||
| FirstName: | SUMAIYA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 S PINEWOOD CREEK CT APT 302 | ||||||||
| Address2: | |||||||||
| City: | NEW BERLIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531519408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043721036 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9200 W WISCONSIN AVE | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532263522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148058710 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2015 | ||||||||
| LastUpdateDate: | 07/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2084N0400X | 83911 | GA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.