Provider Demographics
NPI:1942685995
Name:FRASER, SKYE (MSPED)
Entity Type:Individual
Prefix:MS
First Name:SKYE
Middle Name:
Last Name:FRASER
Suffix:
Gender:F
Credentials:MSPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 6TH ST APT 10
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3715
Mailing Address - Country:US
Mailing Address - Phone:718-300-3517
Mailing Address - Fax:
Practice Address - Street 1:573 6TH ST APT 10
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3715
Practice Address - Country:US
Practice Address - Phone:718-300-3517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY873425171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor