Healthcare Provider Details

I. General information

NPI: 1184128126
Provider Name (Legal Business Name): SADE DIAHANN FRAZIER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 US HIGHWAY 22 STE 1
MOUNTAINSIDE NJ
07092-2890
US

IV. Provider business mailing address

PO BOX 2357
BLOOMFIELD NJ
07003-9157
US

V. Phone/Fax

Practice location:
  • Phone: 908-386-5517
  • Fax: 908-504-8042
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number309576
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number309576
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number309576
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number25MB11270900
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MB11270900
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number25MB11270900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: