Provider Demographics
NPI:1790582393
Name:GHALEY, SARADA
Entity type:Individual
Prefix:
First Name:SARADA
Middle Name:
Last Name:GHALEY
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 1:3160 33RD ST S APT 208
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-7837
Mailing Address - Country:US
Mailing Address - Phone:701-730-7385
Mailing Address - Fax:
Practice Address - Street 1:2596 FULTON LOOP S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-2901
Practice Address - Country:US
Practice Address - Phone:701-730-7385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health