Provider Demographics
NPI:1407105257
Name:NYE, FABRICE (PHD)
Entity Type:Individual
Prefix:
First Name:FABRICE
Middle Name:
Last Name:NYE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 SEAPORT CT
Mailing Address - Street 2:SUITE 104
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-2735
Mailing Address - Country:US
Mailing Address - Phone:650-262-5582
Mailing Address - Fax:650-261-9181
Practice Address - Street 1:503 SEAPORT CT STE 104
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-5566
Practice Address - Country:US
Practice Address - Phone:650-262-5582
Practice Address - Fax:650-261-9181
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist