MEDICARE: FAREEDA RAHAMATULLA

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	372500000X	Chore Provider	234493	FL
2	372600000X	Adult Companion	234493	FL
3	376J00000X	Homemaker	234493	FL

General Provider Information

NPI Number	:	1043751878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAREEDA RAHAMATULLA

Provider Business Mailing Address
First Line	:	1222 SE 47TH ST STE 309
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-9661
Country	:	US
Telephone Number	:	239-217-7637
Fax Number	:

Provider Business Practice Location Address
First Line	:	1222 SE 47TH ST STE 309
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-9661
Country	:	US
Telephone Number	:	239-217-7637
Fax Number	:

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

Provider Enumeration Date	:	03/13/2017
Last Update Date	:	03/13/2017

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Directions to “ FAREEDA RAHAMATULLA ” Practice Location

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