Provider Demographics
NPI:1215672258
Name:FUENTES, INGRID SUHEY
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:SUHEY
Last Name:FUENTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 BROADHOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-5000
Mailing Address - Country:US
Mailing Address - Phone:631-483-5600
Mailing Address - Fax:
Practice Address - Street 1:610 BROADHOLLOW RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-5000
Practice Address - Country:US
Practice Address - Phone:316-483-5600
Practice Address - Fax:316-390-1891
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33863201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine