Provider Demographics
NPI:1750644621
Name:PETRAS, FAYE F (MSED)
Entity Type:Individual
Prefix:MS
First Name:FAYE
Middle Name:F
Last Name:PETRAS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 LESLIE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1448
Mailing Address - Country:US
Mailing Address - Phone:718-420-4961
Mailing Address - Fax:718-420-4961
Practice Address - Street 1:122 LESLIE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1448
Practice Address - Country:US
Practice Address - Phone:718-420-4961
Practice Address - Fax:718-420-4961
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-16
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist