Provider Demographics
NPI:1205286127
Name:SAYAH-PEDRAM, SANDY P
Entity type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:P
Last Name:SAYAH-PEDRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:P
Other - Last Name:PEDRAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JD
Mailing Address - Street 1:14550 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2210
Mailing Address - Country:US
Mailing Address - Phone:818-901-4879
Mailing Address - Fax:
Practice Address - Street 1:14550 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2210
Practice Address - Country:US
Practice Address - Phone:818-901-4879
Practice Address - Fax:818-997-3968
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF94147106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist