Provider Demographics
NPI:1629854336
Name:LLOYD, FAIRY
Entity Type:Individual
Prefix:
First Name:FAIRY
Middle Name:
Last Name:LLOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 N STEMMONS FWY # 3021
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-3832
Mailing Address - Country:US
Mailing Address - Phone:469-905-2401
Mailing Address - Fax:
Practice Address - Street 1:8500 N STEMMONS FWY # 3021
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-3832
Practice Address - Country:US
Practice Address - Phone:469-905-2401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management