Provider Demographics
NPI:1194045732
Name:PERSAUD-ROBERT, VANESSA
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:PERSAUD-ROBERT
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 1:316 5TH AVE
Mailing Address - Street 2:ROOM 404
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3602
Mailing Address - Country:US
Mailing Address - Phone:212-868-0946
Mailing Address - Fax:212-665-6895
Practice Address - Street 1:316 5TH AVE
Practice Address - Street 2:ROOM 404
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3602
Practice Address - Country:US
Practice Address - Phone:212-868-0946
Practice Address - Fax:212-665-6895
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-06
Last Update Date:2010-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY627357163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse