Provider Demographics
NPI:1710574645
Name:VANDUNK, VICTORIO AC (FNP-C)
Entity Type:Individual
Prefix:
First Name:VICTORIO
Middle Name:AC
Last Name:VANDUNK
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 WHITE PLAINS RD APT 25E
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5528
Mailing Address - Country:US
Mailing Address - Phone:845-323-9637
Mailing Address - Fax:
Practice Address - Street 1:177 WHITE PLAINS RD APT 25E
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5528
Practice Address - Country:US
Practice Address - Phone:845-323-9637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-27
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344608363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily