Provider Demographics
NPI:1336233352
Name:FALK, SARAJO BUNNY (PSYDPA)
Entity Type:Individual
Prefix:
First Name:SARAJO
Middle Name:BUNNY
Last Name:FALK
Suffix:
Gender:F
Credentials:PSYDPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 934068
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33093-4068
Mailing Address - Country:US
Mailing Address - Phone:954-366-2700
Mailing Address - Fax:954-366-2056
Practice Address - Street 1:3410 ROSE HILL WAY
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-5130
Practice Address - Country:US
Practice Address - Phone:954-731-0690
Practice Address - Fax:954-366-2056
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5737103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54395AMedicare ID - Type Unspecified