Provider Demographics
NPI:1376680793
Name:FAHMY, SANDRA A
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:A
Last Name:FAHMY
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 1:343 CROWELLS RD APT D
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-3339
Mailing Address - Country:US
Mailing Address - Phone:732-317-2697
Mailing Address - Fax:
Practice Address - Street 1:277 GEORGE ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1311
Practice Address - Country:US
Practice Address - Phone:732-235-6700
Practice Address - Fax:732-235-6726
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22HI00077200124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist