Provider Demographics
NPI:1922506476
Name:GRAHAM, SAYAN A (ARNP)
Entity Type:Individual
Prefix:
First Name:SAYAN
Middle Name:A
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 NW 29TH CT
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1105
Mailing Address - Country:US
Mailing Address - Phone:954-729-7706
Mailing Address - Fax:
Practice Address - Street 1:3304 NW 29TH CT
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33311-1105
Practice Address - Country:US
Practice Address - Phone:954-729-7706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9270980363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner