Provider Demographics
NPI:1679819791
Name:SALLAY, VENUS
Entity Type:Individual
Prefix:MS
First Name:VENUS
Middle Name:
Last Name:SALLAY
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 1:1780 GRAND CONCOURSE
Mailing Address - Street 2:BRONX
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1780 GRAND CONCOURSE
Practice Address - Street 2:BRONX
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5500
Practice Address - Country:US
Practice Address - Phone:718-583-1800
Practice Address - Fax:718-583-4160
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335487363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily