Provider Demographics
NPI:1316223613
Name:SAADA, FAHED
Entity Type:Individual
Prefix:
First Name:FAHED
Middle Name:
Last Name:SAADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1807
Mailing Address - Country:US
Mailing Address - Phone:315-448-5704
Mailing Address - Fax:
Practice Address - Street 1:5000 BRITTONFIELD PKWY # 166
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9226
Practice Address - Country:US
Practice Address - Phone:315-634-5550
Practice Address - Fax:315-634-5551
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2840932084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH57-020348Medicaid