Provider Demographics
NPI:1114327285
Name:FYFE, ELENA (PA)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:FYFE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 MCARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-3174
Mailing Address - Country:US
Mailing Address - Phone:413-770-3126
Mailing Address - Fax:
Practice Address - Street 1:55 PITTSFIELD RD STE 12C
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2122
Practice Address - Country:US
Practice Address - Phone:413-344-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1262772363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical