Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TH0100X | Health Service | 465173-1 | NY |
NPI | 1366706913 |
---|---|
Provider Name | Shrena Fraser |
First Address | New Rochelle, NY 10802-1228 |
Second Address | New Rochelle, NY 10801-6412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2012 |
Last Update Date | 28/06/2012 |