Provider Demographics
NPI:1184477176
Name:BUTHELEZI ESTES, FUNDA (DC)
Entity type:Individual
Prefix:DR
First Name:FUNDA
Middle Name:
Last Name:BUTHELEZI ESTES
Suffix:
Gender:X
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1518
Mailing Address - Country:US
Mailing Address - Phone:914-817-3259
Mailing Address - Fax:
Practice Address - Street 1:632 UTICA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2210
Practice Address - Country:US
Practice Address - Phone:347-955-4979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2841997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty