Provider Demographics
NPI:1124845938
Name:FARAHAT, WALEED
Entity type:Individual
Prefix:MR
First Name:WALEED
Middle Name:
Last Name:FARAHAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 N LAKEWALK DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-1305
Mailing Address - Country:US
Mailing Address - Phone:386-864-9766
Mailing Address - Fax:
Practice Address - Street 1:148 N LAKEWALK DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-1305
Practice Address - Country:US
Practice Address - Phone:386-864-9766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9440514163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse