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Individual

SARAH SHANTI FAZEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
IDAHO DEPARTMENT OF HEALTH AND WELFARE, 1720 WESTGATE DR. SUITE D, BOISE, ID 83704
(208) 334-0921
Mailing address
219 S DIAMOND ST, NAMPA, ID 83686-5315
(208) 965-1955

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary

Other

Enumeration date
04/20/2021
Last updated
04/20/2021
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