Healthcare Provider Details

I. General information

NPI: 1538539929
Provider Name (Legal Business Name): FEHID MEHIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 FLY RD
EAST SYRACUSE NY
13057-9791
US

IV. Provider business mailing address

6620 FLY RD
EAST SYRACUSE NY
13057-9791
US

V. Phone/Fax

Practice location:
  • Phone: 315-470-7111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number339771
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402594
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: