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General NPI Number Information
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NPI Number | 1770043259
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Entity Type | Individual
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Provider Name | FADI KANDAH DO
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Gender | Male
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Dates
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Enumeration Date | 03/21/2019
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 100 WHETSTONE PL STE 102
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-5775
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Country | US
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Telephone | 904-342-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 100 WHETSTONE PL STE 102
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-5775
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Country | US
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Telephone | 904-342-8300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | OS22197
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | UO6500
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License Number State | FL
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