Provider Demographics
NPI:1144373994
Name:SABA, WAFA (MD)
Entity type:Individual
Prefix:DR
First Name:WAFA
Middle Name:
Last Name:SABA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:WAFA
Other - Middle Name:SABA
Other - Last Name:SULTANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:927 MAY ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-3602
Mailing Address - Country:US
Mailing Address - Phone:662-627-7169
Mailing Address - Fax:662-621-9282
Practice Address - Street 1:927 MAY ST
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-3602
Practice Address - Country:US
Practice Address - Phone:662-627-7169
Practice Address - Fax:662-621-9282
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16315174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0120659Medicaid