Provider Demographics
NPI:1043751878
Name:RAHAMATULLA, FAREEDA
Entity Type:Individual
Prefix:
First Name:FAREEDA
Middle Name:
Last Name:RAHAMATULLA
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 1:1222 SE 47TH ST STE 309
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-9661
Mailing Address - Country:US
Mailing Address - Phone:239-217-7637
Mailing Address - Fax:
Practice Address - Street 1:1222 SE 47TH ST STE 309
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9661
Practice Address - Country:US
Practice Address - Phone:239-217-7637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL234493372500000X, 372600000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion