Provider Demographics
NPI:1932391851
Name:TABER, FAYE E (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:FAYE
Middle Name:E
Last Name:TABER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4955 N BAILEY AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1206
Mailing Address - Country:US
Mailing Address - Phone:716-320-0629
Mailing Address - Fax:208-684-7112
Practice Address - Street 1:4955 N BAILEY AVE STE 214
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14226-1206
Practice Address - Country:US
Practice Address - Phone:716-982-1548
Practice Address - Fax:208-684-7112
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401584363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03625005Medicaid