Provider Demographics
NPI:1154312403
Name:FAYNBOYM, NATALYA B (MD)
Entity Type:Individual
Prefix:DR
First Name:NATALYA
Middle Name:B
Last Name:FAYNBOYM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13640 N PLAZA DEL RIO BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4846
Mailing Address - Country:US
Mailing Address - Phone:623-876-3800
Mailing Address - Fax:623-876-6965
Practice Address - Street 1:9165 W THUNDERBIRD RD
Practice Address - Street 2:STE 100
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4847
Practice Address - Country:US
Practice Address - Phone:623-523-6560
Practice Address - Fax:623-523-6581
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34352208100000X
NC2007-00545208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907194Medicaid
SCQ45007Medicaid
VA1154312403Medicaid
AZ968505Medicaid
WV3810009395Medicaid
NC5907194Medicaid
AZZ136077Medicare PIN