Provider Demographics
NPI:1659681369
Name:MCKAY, VANESSA JEAN (LAC)
Entity Type:Individual
Prefix:MISS
First Name:VANESSA
Middle Name:JEAN
Last Name:MCKAY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 ROUTE 303 SUITE #3
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962
Mailing Address - Country:US
Mailing Address - Phone:845-825-9287
Mailing Address - Fax:
Practice Address - Street 1:516 ROUTE 303 SUITE #3
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962
Practice Address - Country:US
Practice Address - Phone:845-825-9287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004453171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist