Provider Demographics
NPI:1639675697
Name:BORDAYO, VICTORIA MARY
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:MARY
Last Name:BORDAYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:MARY
Other - Last Name:ROMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3411 PICKWICK PL
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1788
Mailing Address - Country:US
Mailing Address - Phone:517-455-3055
Mailing Address - Fax:
Practice Address - Street 1:3411 PICKWICK PL
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1788
Practice Address - Country:US
Practice Address - Phone:517-455-3055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider