Provider Demographics
NPI:1578965083
Name:OBERG, FAYE (DVM)
Entity Type:Individual
Prefix:DR
First Name:FAYE
Middle Name:
Last Name:OBERG
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 WASHINGTON BLVD
Mailing Address - Street 2:APT 801S
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2451
Mailing Address - Country:US
Mailing Address - Phone:203-804-9906
Mailing Address - Fax:
Practice Address - Street 1:895 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4621
Practice Address - Country:US
Practice Address - Phone:203-929-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003960174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian