MEDICARE: FANEEZA RUSTAM

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1922965102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FANEEZA RUSTAM

Provider Business Mailing Address
First Line	:	1515 N UNIVERSITY DR STE 221
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6032
Country	:	US
Telephone Number	:	561-778-2640
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 N UNIVERSITY DR STE 221
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6032
Country	:	US
Telephone Number	:	561-778-2640
Fax Number	:

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

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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Directions to “ FANEEZA RUSTAM ” Practice Location

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