Healthcare Provider Details

I. General information

NPI: 1861304594
Provider Name (Legal Business Name): KRISTIN FAHED PEER SPECIALIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 NORTH ST
HARRISON NY
10528-1140
US

IV. Provider business mailing address

275 NORTH ST
HARRISON NY
10528-1140
US

V. Phone/Fax

Practice location:
  • Phone: 914-925-3612
  • Fax: 914-925-5169
Mailing address:
  • Phone: 914-925-3612
  • Fax: 914-925-5169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberNYCPS-P-552348
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: