Healthcare Provider Details

I. General information

NPI: 1407105257
Provider Name (Legal Business Name): FABRICE NYE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 SEAPORT CT STE 104
REDWOOD CITY CA
94063-5566
US

IV. Provider business mailing address

503 SEAPORT CT SUITE 104
REDWOOD CITY CA
94063-2735
US

V. Phone/Fax

Practice location:
  • Phone: 650-262-5582
  • Fax: 650-261-9181
Mailing address:
  • Phone: 650-262-5582
  • Fax: 650-261-9181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: