Provider Demographics
NPI:1659248102
Name:MANNY, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MANNY
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 1:93 MANSEAU ST APT B
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-1581
Mailing Address - Country:US
Mailing Address - Phone:802-242-1633
Mailing Address - Fax:
Practice Address - Street 1:93 MANSEAU ST APT B
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1581
Practice Address - Country:US
Practice Address - Phone:802-242-1633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0134930390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program