Healthcare Provider Details

I. General information

NPI: 1295440758
Provider Name (Legal Business Name): CINDY CARYOL TABOR-FEDELE SUD COUNSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CINDY C FEDELE

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 W SHAW AVE # 102
FRESNO CA
93711-3706
US

IV. Provider business mailing address

1204 W SHAW AVE STE 102
FRESNO CA
93711-3706
US

V. Phone/Fax

Practice location:
  • Phone: 559-681-1947
  • Fax:
Mailing address:
  • Phone: 559-681-1947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number33263
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: