Provider Demographics
NPI:1144567868
Name:DR DANUTA B FABISIAK PA
Entity Type:Organization
Organization Name:DR DANUTA B FABISIAK PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANUTA
Authorized Official - Middle Name:B
Authorized Official - Last Name:FABISIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-795-7222
Mailing Address - Street 1:2110 58TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5660
Mailing Address - Country:US
Mailing Address - Phone:941-795-7222
Mailing Address - Fax:941-795-7335
Practice Address - Street 1:2110 58TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5660
Practice Address - Country:US
Practice Address - Phone:941-795-7222
Practice Address - Fax:941-795-7335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS84742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty