Provider Demographics
NPI:1417288788
Name:VELLA, TONI JEAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:JEAN
Last Name:VELLA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2395 W GENESEE TPKE
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-9612
Mailing Address - Country:US
Mailing Address - Phone:315-657-0335
Mailing Address - Fax:
Practice Address - Street 1:2395 W GENESEE TPKE
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-9612
Practice Address - Country:US
Practice Address - Phone:315-657-0335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283473164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse