Provider Demographics
NPI:1093563652
Name:FERGUSON, HEATHER (MSED)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:810 MIRABELLE AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6117
Mailing Address - Country:US
Mailing Address - Phone:516-816-7541
Mailing Address - Fax:
Practice Address - Street 1:810 MIRABELLE AVE
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-6117
Practice Address - Country:US
Practice Address - Phone:516-816-7541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist