MEDICARE: FARHIYA IBRAHIM ISSAK

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1447147103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARHIYA IBRAHIM ISSAK

Provider Business Mailing Address
First Line	:	419 MAYFAIR BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2238
Country	:	US
Telephone Number	:	207-533-4336
Fax Number	:

Provider Business Practice Location Address
First Line	:	4464 LARWELL DRIVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220
Country	:	US
Telephone Number	:	614-487-7805
Fax Number	:	614-487-7809

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

Provider Enumeration Date	:	06/23/2025
Last Update Date	:	08/11/2025

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