Healthcare Provider Details

I. General information

NPI: 1306093109
Provider Name (Legal Business Name): SANDY ABDELKEDOUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 E DAKOTA AVE
FRESNO CA
93726-4821
US

IV. Provider business mailing address

44444 20TH ST W
LANCASTER CA
93534-2714
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-9180
  • Fax: 559-455-4783
Mailing address:
  • Phone: 661-951-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberN/A
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA126253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: