MEDICARE: DR. ANGELINA FAYNLEYB DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	059778	NY

General Provider Information

NPI Number	:	1245764760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELINA FAYNLEYB DDS

Provider Business Mailing Address
First Line	:	46 DONLEY AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-1651
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	672 PARKSIDE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-2298
Country	:	US
Telephone Number	:	718-247-8400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2017
Last Update Date	:	07/12/2021

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