Provider Demographics
NPI:1326442252
Name:ALFARIS, SAUSAN
Entity Type:Individual
Prefix:
First Name:SAUSAN
Middle Name:
Last Name:ALFARIS
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 1:521 S BROAD ST
Mailing Address - Street 2:APT 412
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1037
Mailing Address - Country:US
Mailing Address - Phone:571-309-8895
Mailing Address - Fax:
Practice Address - Street 1:240 S 40TH ST # 122
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-6030
Practice Address - Country:US
Practice Address - Phone:215-898-8943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
XXXXXXXXXXXXXXXXXXXX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program