Provider Demographics
NPI:1144570086
Name:VELOZA-VALERO, JACQUELINE (MSED)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:
Last Name:VELOZA-VALERO
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 1:25-58 32ND. STREET
Mailing Address - Street 2:1ST FL
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102
Mailing Address - Country:US
Mailing Address - Phone:347-262-6763
Mailing Address - Fax:
Practice Address - Street 1:36-02 14TH ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106
Practice Address - Country:US
Practice Address - Phone:718-392-2510
Practice Address - Fax:718-392-2637
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY558405111174400000X
NY562850111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist