Provider Demographics
NPI:1376616458
Name:VAUGHAN-DAVIS, NADINE N (MSW CANDIDATE)
Entity Type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:N
Last Name:VAUGHAN-DAVIS
Suffix:
Gender:F
Credentials:MSW CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 ELMONT RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3535
Mailing Address - Country:US
Mailing Address - Phone:516-437-6050
Mailing Address - Fax:516-437-6304
Practice Address - Street 1:570 ELMONT RD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-3535
Practice Address - Country:US
Practice Address - Phone:516-437-6050
Practice Address - Fax:516-437-6304
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01666971Medicaid