Provider Demographics
NPI:1427664598
Name:FAHIE, SEQUOYA D
Entity type:Individual
Prefix:
First Name:SEQUOYA
Middle Name:D
Last Name:FAHIE
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 1:18906 NASHVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-1021
Mailing Address - Country:US
Mailing Address - Phone:347-551-4197
Mailing Address - Fax:
Practice Address - Street 1:18906 NASHVILLE BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-1021
Practice Address - Country:US
Practice Address - Phone:347-551-4197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066606183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist