MEDICARE: SANDY FARIDA

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	363L00000X	Nurse Practitioner	4704252160	MI

General Provider Information

NPI Number	:	1497091631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDY FARIDA

Provider Business Mailing Address
First Line	:	6814 COTTONWOOD KNL
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3846
Country	:	US
Telephone Number	:	248-224-4776
Fax Number	:

Provider Business Practice Location Address
First Line	:	6814 COTTONWOOD KNL
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3846
Country	:	US
Telephone Number	:	248-224-4776
Fax Number	:

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

Provider Enumeration Date	:	12/17/2012
Last Update Date	:	12/17/2012

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Directions to “ SANDY FARIDA ” Practice Location

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