MEDICARE: FARIDA FARZANA

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	2084P0800X	Psychiatry Physician	R6817	MO

General Provider Information

NPI Number	:	1346349743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARIDA FARZANA

Provider Business Mailing Address
First Line	:	3115 HAMPTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-2303
Country	:	US
Telephone Number	:	314-644-3447
Fax Number	:

Provider Business Practice Location Address
First Line	:	3115 HAMPTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-2303
Country	:	US
Telephone Number	:	314-644-3447
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FARIDA FARZANA
Credential	:	MD
Telephone Number	:	314-644-3447

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	08/22/2020

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