Provider Demographics
NPI:1497221147
Name:DE ASSIS, VANESSA
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:DE ASSIS
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 1:7810 ARBOR GROVE DR APT 401
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1901
Mailing Address - Country:US
Mailing Address - Phone:813-391-1946
Mailing Address - Fax:
Practice Address - Street 1:301 SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2102
Practice Address - Country:US
Practice Address - Phone:410-659-2963
Practice Address - Fax:410-332-9789
Is Sole Proprietor?:No
Enumeration Date:2018-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical