Provider Demographics
NPI:1831977560
Name:SUBOH, FEDAA FAHMY
Entity type:Individual
Prefix:DR
First Name:FEDAA
Middle Name:FAHMY
Last Name:SUBOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 ROBIN RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1036
Mailing Address - Country:US
Mailing Address - Phone:716-482-5664
Mailing Address - Fax:
Practice Address - Street 1:3249 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1435
Practice Address - Country:US
Practice Address - Phone:716-835-0533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070242-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist