Provider Demographics
NPI:1740085257
Name:SADEQ, SURA
Entity type:Individual
Prefix:
First Name:SURA
Middle Name:
Last Name:SADEQ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 115TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4419
Mailing Address - Country:US
Mailing Address - Phone:402-359-1265
Mailing Address - Fax:402-315-3517
Practice Address - Street 1:3121 N HILL RD APT 105
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-4714
Practice Address - Country:US
Practice Address - Phone:949-929-0241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide