Provider Demographics
NPI:1699533513
Name:SALLAH, HADDY
Entity type:Individual
Prefix:
First Name:HADDY
Middle Name:
Last Name:SALLAH
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 1:11732 MONROVIA ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1396
Mailing Address - Country:US
Mailing Address - Phone:913-269-6056
Mailing Address - Fax:
Practice Address - Street 1:11732 MONROVIA ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1396
Practice Address - Country:US
Practice Address - Phone:913-269-6056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services