Provider Demographics
NPI:1043622632
Name:TAYEBALY, SUMRA (MD)
Entity type:Individual
Prefix:
First Name:SUMRA
Middle Name:
Last Name:TAYEBALY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3594
Mailing Address - Country:US
Mailing Address - Phone:609-924-9300
Mailing Address - Fax:609-430-9481
Practice Address - Street 1:419 N HARRISON ST STE 201
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3521
Practice Address - Country:US
Practice Address - Phone:609-924-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT207028207V00000X
NJ25MA10428000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty