Provider Demographics
NPI:1083125173
Name:VANSIEA, JUDY EDVALINE (DNP, MA,MS,APRN-NPP)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:EDVALINE
Last Name:VANSIEA
Suffix:
Gender:F
Credentials:DNP, MA,MS,APRN-NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 RXR PLZ FL 6
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556-0626
Mailing Address - Country:US
Mailing Address - Phone:516-247-3525
Mailing Address - Fax:
Practice Address - Street 1:626 RXR PLZ FL 6
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11556-0626
Practice Address - Country:US
Practice Address - Phone:516-247-3525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY495122-1163W00000X, 163W00000X
NYF401816-1363LP0808X, 363LP0808X
GARN267072163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty