Provider Demographics
NPI:1407396278
Name:VELESIG, DUSTY
Entity Type:Individual
Prefix:
First Name:DUSTY
Middle Name:
Last Name:VELESIG
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 1:457 DINNERBELL RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16002-7703
Mailing Address - Country:US
Mailing Address - Phone:724-244-1509
Mailing Address - Fax:
Practice Address - Street 1:457 DINNERBELL RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16002-7703
Practice Address - Country:US
Practice Address - Phone:724-244-1509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032197160001Medicaid