Provider Demographics
NPI:1194428219
Name:CHARLERY, FAYE
Entity type:Individual
Prefix:
First Name:FAYE
Middle Name:
Last Name:CHARLERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FAYE
Other - Middle Name:
Other - Last Name:CHARLERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:569 WYONA ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-5819
Mailing Address - Country:US
Mailing Address - Phone:347-355-0679
Mailing Address - Fax:
Practice Address - Street 1:569 WYONA ST APT 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-5819
Practice Address - Country:US
Practice Address - Phone:347-355-0679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1678677231174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist