Healthcare Provider Details

I. General information

NPI: 1528709821
Provider Name (Legal Business Name): DREW ALEXANDER FAJARDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

4800 SAND POINT WAY NE # OC.7830
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberML61295792
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: