Provider Demographics
NPI:1073346664
Name:NAKKAZI, FARIDAH
Entity type:Individual
Prefix:
First Name:FARIDAH
Middle Name:
Last Name:NAKKAZI
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 1:14928 HYDRUS RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-1828
Mailing Address - Country:US
Mailing Address - Phone:202-903-4481
Mailing Address - Fax:
Practice Address - Street 1:2924 BEL PRE RD APT 101
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2404
Practice Address - Country:US
Practice Address - Phone:202-578-4736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHCSA-00720251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health