Provider Demographics
NPI:1073211553
Name:ZAYED, FEDAA M
Entity Type:Individual
Prefix:MRS
First Name:FEDAA
Middle Name:M
Last Name:ZAYED
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 1:7914 S 82ND AVE APT 1N
Mailing Address - Street 2:
Mailing Address - City:JUSTICE
Mailing Address - State:IL
Mailing Address - Zip Code:60458-1530
Mailing Address - Country:US
Mailing Address - Phone:708-262-6696
Mailing Address - Fax:
Practice Address - Street 1:7914 S 82ND AVE APT 2N
Practice Address - Street 2:
Practice Address - City:JUSTICE
Practice Address - State:IL
Practice Address - Zip Code:60458-1530
Practice Address - Country:US
Practice Address - Phone:708-262-6696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL106S00000XOtherTAXONOMY