Provider Demographics
NPI:1801159223
Name:ECHEVERRY, FERNANDO
Entity type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:
Last Name:ECHEVERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:LUIS
Other - Middle Name:FERNANDO
Other - Last Name:ECHEVERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:202 STREET
Mailing Address - Street 2:33-27
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1143
Mailing Address - Country:US
Mailing Address - Phone:917-834-3061
Mailing Address - Fax:347-502-7184
Practice Address - Street 1:2 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:SYSOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791
Practice Address - Country:US
Practice Address - Phone:516-496-4460
Practice Address - Fax:516-921-4432
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker