Provider Demographics
NPI:1649386715
Name:JUNOR, VANESSA EULINDA (DO)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:EULINDA
Last Name:JUNOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6668 FOURTH SECTION ROAD
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420
Mailing Address - Country:US
Mailing Address - Phone:585-637-2670
Mailing Address - Fax:585-637-3678
Practice Address - Street 1:6668 FOURTH SECTION ROAD
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420
Practice Address - Country:US
Practice Address - Phone:585-637-2670
Practice Address - Fax:585-637-3678
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235519207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02675890Medicaid
NYJ400072725/GRP70008AMedicare PIN
NYJ400072723/GRPBA0017Medicare PIN