Provider Demographics
NPI:1467622548
Name:RODRIGUES, PAULA VANESSA
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:VANESSA
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:PAULA
Other - Middle Name:VANESSA
Other - Last Name:MARTINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:417 NORTH BROAWAY
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753
Mailing Address - Country:US
Mailing Address - Phone:516-938-9400
Mailing Address - Fax:516-433-3409
Practice Address - Street 1:417 N BROADWAY
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2106
Practice Address - Country:US
Practice Address - Phone:516-938-9400
Practice Address - Fax:516-433-3409
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist