Provider Demographics
NPI:1578358511
Name:SULTANBAEV, VIKTORIJA
Entity type:Individual
Prefix:
First Name:VIKTORIJA
Middle Name:
Last Name:SULTANBAEV
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 HARTSHORE WAY
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-2307
Mailing Address - Country:US
Mailing Address - Phone:718-915-8774
Mailing Address - Fax:
Practice Address - Street 1:3709 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3507
Practice Address - Country:US
Practice Address - Phone:718-444-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF356373-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily