Provider Demographics
NPI:1275982274
Name:DISLA DE JESUS, VANESA DEL PILAR (MD)
Entity Type:Individual
Prefix:
First Name:VANESA
Middle Name:DEL PILAR
Last Name:DISLA DE JESUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 W WATER ST APT 408
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1095
Mailing Address - Country:US
Mailing Address - Phone:646-726-1334
Mailing Address - Fax:
Practice Address - Street 1:100 2ND AVE N STE 320
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3338
Practice Address - Country:US
Practice Address - Phone:727-564-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1559302084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry