Provider Demographics
NPI:1194111633
Name:FIANOO, MAVIS TEYE (LPN)
Entity type:Individual
Prefix:DR
First Name:MAVIS
Middle Name:TEYE
Last Name:FIANOO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 DALY AVE
Mailing Address - Street 2:1ST FL
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-2889
Mailing Address - Country:US
Mailing Address - Phone:646-287-9507
Mailing Address - Fax:
Practice Address - Street 1:50 CLINTON ST
Practice Address - Street 2:SUITE 600
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4281
Practice Address - Country:US
Practice Address - Phone:516-493-9063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-11
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321719-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse