MEDICARE: BERYL SANDRA FANI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1548933039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERYL SANDRA FANI

Provider Business Mailing Address
First Line	:	7401 NEW HAMPSHIRE AVE APT 611
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-6950
Country	:	US
Telephone Number	:	301-328-6354
Fax Number	:

Provider Business Practice Location Address
First Line	:	7401 NEW HAMPSHIRE AVE APT 611
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-6950
Country	:	US
Telephone Number	:	301-328-6354
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2021
Last Update Date	:	07/29/2021

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