Provider Demographics
NPI:1467044925
Name:CARVALHO, VINICIUS DALESSANDRO
Entity Type:Individual
Prefix:
First Name:VINICIUS
Middle Name:DALESSANDRO
Last Name:CARVALHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SUMMIT AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-1575
Mailing Address - Country:US
Mailing Address - Phone:914-562-2734
Mailing Address - Fax:
Practice Address - Street 1:18 SUMMIT AVE APT 1
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1575
Practice Address - Country:US
Practice Address - Phone:914-562-2734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-06
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010090225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist