Healthcare Provider Details

I. General information

NPI: 1578965083
Provider Name (Legal Business Name): FAYE OBERG DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 BRIDGEPORT AVE
SHELTON CT
06484-4621
US

IV. Provider business mailing address

1450 WASHINGTON BLVD APT 801S
STAMFORD CT
06902-2451
US

V. Phone/Fax

Practice location:
  • Phone: 203-929-8600
  • Fax:
Mailing address:
  • Phone: 203-804-9906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number003960
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: