Provider Demographics
NPI:1023370376
Name:REYES, VIRIDIANA (MSED)
Entity Type:Individual
Prefix:
First Name:VIRIDIANA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8437 FLEET CT
Mailing Address - Street 2:APT 77B
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2449
Mailing Address - Country:US
Mailing Address - Phone:347-666-9079
Mailing Address - Fax:
Practice Address - Street 1:8437 FLEET CT
Practice Address - Street 2:APT 77B
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2449
Practice Address - Country:US
Practice Address - Phone:347-666-9079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No252Y00000XAgenciesEarly Intervention Provider Agency