Provider Demographics
NPI:1790666204
Name:SANDERS, QADIR ABDUL RAHMAN
Entity type:Individual
Prefix:MR
First Name:QADIR
Middle Name:ABDUL RAHMAN
Last Name:SANDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 SHADY KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-6285
Mailing Address - Country:US
Mailing Address - Phone:910-644-3583
Mailing Address - Fax:
Practice Address - Street 1:1808 SHADY KNOLL LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-6285
Practice Address - Country:US
Practice Address - Phone:910-644-3583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician