Provider Demographics
NPI:1326705195
Name:CARNEIRO VIEIRA DA ROCHA, FERNANDA
Entity Type:Individual
Prefix:
First Name:FERNANDA
Middle Name:
Last Name:CARNEIRO VIEIRA DA ROCHA
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 1:1867 PUTNAM AVE APT 3L
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-4317
Mailing Address - Country:US
Mailing Address - Phone:608-609-4912
Mailing Address - Fax:
Practice Address - Street 1:1867 PUTNAM AVE APT 3L
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-4317
Practice Address - Country:US
Practice Address - Phone:608-609-4912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program