Provider Demographics
NPI:1184331282
Name:JIWANI, FIYAZ FARHAD
Entity type:Individual
Prefix:
First Name:FIYAZ
Middle Name:FARHAD
Last Name:JIWANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5782 LAKE CYRUS BLVD
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4195
Mailing Address - Country:US
Mailing Address - Phone:205-413-3249
Mailing Address - Fax:
Practice Address - Street 1:1820 SOUTHPARK DR
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-2094
Practice Address - Country:US
Practice Address - Phone:205-961-4726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7954568106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician