Provider Demographics
NPI:1003236621
Name:DAOU, FATEN
Entity Type:Individual
Prefix:
First Name:FATEN
Middle Name:
Last Name:DAOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MEADOWS RD STE 103
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2346
Mailing Address - Country:US
Mailing Address - Phone:561-245-7464
Mailing Address - Fax:561-990-7149
Practice Address - Street 1:801 MEADOWS RD STE 103
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2346
Practice Address - Country:US
Practice Address - Phone:561-245-7464
Practice Address - Fax:561-990-7149
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005258171100000X
NJ25MZ00105300171100000X
FLAP3409171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist