Provider Demographics
NPI:1346723681
Name:YORK, DEBORAH VANESSA (CPNPPC)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:VANESSA
Last Name:YORK
Suffix:
Gender:F
Credentials:CPNPPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3978
Mailing Address - Country:US
Mailing Address - Phone:718-991-0605
Mailing Address - Fax:
Practice Address - Street 1:890 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3978
Practice Address - Country:US
Practice Address - Phone:718-991-0605
Practice Address - Fax:347-498-2751
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382912363LP0200X, 363LP0200X
NY750642163W00000X
CT7926363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse