Provider Demographics
NPI:1306223649
Name:FAYNIK, DEBORAH (COMS)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:FAYNIK
Suffix:
Gender:F
Credentials:COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 BUELL AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6940
Mailing Address - Country:US
Mailing Address - Phone:815-722-0154
Mailing Address - Fax:
Practice Address - Street 1:1004 BUELL AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6940
Practice Address - Country:US
Practice Address - Phone:815-722-0154
Practice Address - Fax:815-722-0154
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1429174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist