Provider Demographics
NPI:1013543487
Name:SHIDID, FARRAH
Entity Type:Individual
Prefix:
First Name:FARRAH
Middle Name:
Last Name:SHIDID
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 1:3136 NY-207
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HALL
Mailing Address - State:NY
Mailing Address - Zip Code:10916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3136 NY ROUTE 207
Practice Address - Street 2:
Practice Address - City:CAMPBELL HALL
Practice Address - State:NY
Practice Address - Zip Code:10916
Practice Address - Country:US
Practice Address - Phone:855-771-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health