Provider Demographics
NPI:1386150720
Name:FRYAR, VINAIYA CHARLAI
Entity type:Individual
Prefix:
First Name:VINAIYA
Middle Name:CHARLAI
Last Name:FRYAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 240089
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-0089
Mailing Address - Country:US
Mailing Address - Phone:917-780-0223
Mailing Address - Fax:
Practice Address - Street 1:2929 W 31ST ST APT 2H1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1708
Practice Address - Country:US
Practice Address - Phone:917-780-0223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0863821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical