Provider Demographics
NPI:1740889799
Name:GOODMAN, FAY ELIZABETH (NP)
Entity type:Individual
Prefix:
First Name:FAY
Middle Name:ELIZABETH
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:FAY
Other - Middle Name:ELIZABETH
Other - Last Name:SHIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:14 PRESERVE COURT
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607
Mailing Address - Country:US
Mailing Address - Phone:201-954-6689
Mailing Address - Fax:
Practice Address - Street 1:777 NORTH BROADWAY
Practice Address - Street 2:SUITE 305
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591
Practice Address - Country:US
Practice Address - Phone:914-366-5420
Practice Address - Fax:914-366-5421
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345941363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF345941OtherNP STATE LICENSE