Provider Demographics
NPI:1386644235
Name:VALLIANI, FARIDA FARRUKH (MD)
Entity Type:Individual
Prefix:DR
First Name:FARIDA
Middle Name:FARRUKH
Last Name:VALLIANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FARIDA
Other - Middle Name:FARRUKH
Other - Last Name:HASSAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3740 N JOSEY LN
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2474
Mailing Address - Country:US
Mailing Address - Phone:214-731-0031
Mailing Address - Fax:214-731-0065
Practice Address - Street 1:3740 N JOSEY LN
Practice Address - Street 2:SUITE 206
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2474
Practice Address - Country:US
Practice Address - Phone:214-731-0031
Practice Address - Fax:214-731-0065
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9413207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113797804Medicaid
TX8A6649Medicare PIN
G16929Medicare UPIN