Provider Demographics
NPI:1003343146
Name:FIDAI, ALIYA
Entity Type:Individual
Prefix:
First Name:ALIYA
Middle Name:
Last Name:FIDAI
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 1:3715 N BUSINESS DR STE 202
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5288
Mailing Address - Country:US
Mailing Address - Phone:479-582-0778
Mailing Address - Fax:479-582-0778
Practice Address - Street 1:3715 N BUSINESS DR STE 202
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5288
Practice Address - Country:US
Practice Address - Phone:479-582-0778
Practice Address - Fax:479-582-0778
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX873223163WC0200X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine