Basic Information
Provider Information
NPI: 1528225232
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FAYAD
FirstName: SARAH
MiddleName: MCMILLEN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1121 NW 64TH TER
Address2: SUITE A
City: GAINESVILLE
State: FL
PostalCode: 326054243
CountryCode: US
TelephoneNumber: 3523313583
FaxNumber: 3523313669
Practice Location
Address1: 6500 W NEWBERRY RD
Address2:  
City: GAINESVILLE
State: FL
PostalCode: 326054309
CountryCode: US
TelephoneNumber: 3523334000
FaxNumber: 3523334800
Other Information
ProviderEnumerationDate: 05/20/2008
LastUpdateDate: 02/10/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800XME109688FLY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

ID Information
IDTypeStateIssuerDescription
00585100005FL MEDICAID


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