Provider Demographics
NPI:1083731665
Name:TYSON, VEDA (NP-P, LMSW, APRN)
Entity Type:Individual
Prefix:MS
First Name:VEDA
Middle Name:
Last Name:TYSON
Suffix:
Gender:F
Credentials:NP-P, LMSW, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7405
Mailing Address - Country:US
Mailing Address - Phone:212-335-2100
Mailing Address - Fax:646-775-4142
Practice Address - Street 1:138 W 25TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7405
Practice Address - Country:US
Practice Address - Phone:212-335-2100
Practice Address - Fax:646-775-4142
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4524363LP0808X
NY683781041C0700X
NY628862163W00000X
CT088298163W00000X
NY401299363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY628862OtherRN LICENSE
NY68378OtherLICENSE
CT088298OtherRN LICENSE
CT4524OtherAPRN LICENSE
NY401299OtherNY STATE DEPARTMENT OF EDUCATION