Provider Demographics
NPI:1609213271
Name:DOPEK, FAYDRA SHANTEL
Entity Type:Individual
Prefix:MRS
First Name:FAYDRA
Middle Name:SHANTEL
Last Name:DOPEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FAYDRA
Other - Middle Name:SHANTEL
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:193 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3309
Mailing Address - Country:US
Mailing Address - Phone:847-322-7729
Mailing Address - Fax:
Practice Address - Street 1:193 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3309
Practice Address - Country:US
Practice Address - Phone:847-322-7729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227009207225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist