Provider Demographics
NPI:1801671656
Name:FIDAI, MEHROSE
Entity type:Individual
Prefix:
First Name:MEHROSE
Middle Name:
Last Name:FIDAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MANCHESTER RD STE 1450
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4534
Mailing Address - Country:US
Mailing Address - Phone:630-940-6828
Mailing Address - Fax:
Practice Address - Street 1:2100 MANCHESTER RD STE 1450
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4534
Practice Address - Country:US
Practice Address - Phone:630-940-6828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical