Healthcare Provider Details

I. General information

NPI: 1962879460
Provider Name (Legal Business Name): SARAH FEDAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W 27TH ST RM 5S
NEW YORK NY
10001-6208
US

IV. Provider business mailing address

4618 CREEKBEND DR
HOUSTON TX
77035-5016
US

V. Phone/Fax

Practice location:
  • Phone: 833-351-8255
  • Fax:
Mailing address:
  • Phone: 832-529-8336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403369
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number832571
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP128646
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: