Provider Demographics
NPI:1841863032
Name:SARPOOLAKI, SAHAR ALEXANDRA
Entity type:Individual
Prefix:MS
First Name:SAHAR
Middle Name:ALEXANDRA
Last Name:SARPOOLAKI
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 1:200 ELDRON BLVD SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-3629
Mailing Address - Country:US
Mailing Address - Phone:321-413-3366
Mailing Address - Fax:321-306-2880
Practice Address - Street 1:200 ELDRON BLVD SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-3629
Practice Address - Country:US
Practice Address - Phone:321-413-3366
Practice Address - Fax:321-306-2880
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician