Basic Information
| Provider Information | |||||||||
| NPI: | 1205286127 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAYAH-PEDRAM | ||||||||
| FirstName: | SANDY | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PEDRAM | ||||||||
| OtherFirstName: | SANDY | ||||||||
| OtherMiddleName: | P. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | J.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 14550 SHERMAN WAY | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914052210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189014879 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14550 SHERMAN WAY | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914052210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189014879 | ||||||||
| FaxNumber: | 8189973968 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2016 | ||||||||
| LastUpdateDate: | 10/05/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF94147 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.