Provider Demographics
NPI:1417280835
Name:ABDULLAH, FARIA (MD)
Entity Type:Individual
Prefix:
First Name:FARIA
Middle Name:
Last Name:ABDULLAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIFAT
Other - Middle Name:
Other - Last Name:FARIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:51 N DUNLAP ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-4625
Mailing Address - Country:US
Mailing Address - Phone:901-287-7337
Mailing Address - Fax:
Practice Address - Street 1:51 N DUNLAP ST
Practice Address - Street 2:SUITE 350
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-4625
Practice Address - Country:US
Practice Address - Phone:516-780-4801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270774208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03631867Medicaid
NY03631867Medicaid