Provider Demographics
NPI:1578930657
Name:FRIED, MINDY (CD(DONA))
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:FRIED
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 NILES PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5025
Mailing Address - Country:US
Mailing Address - Phone:718-494-4343
Mailing Address - Fax:
Practice Address - Street 1:23 NILES PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5025
Practice Address - Country:US
Practice Address - Phone:718-494-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist