Provider Demographics
NPI:1801218631
Name:SMITH, VONDA DENISE (RN,IBCLC)
Entity Type:Individual
Prefix:MS
First Name:VONDA
Middle Name:DENISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19814 100TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-3316
Mailing Address - Country:US
Mailing Address - Phone:718-877-9654
Mailing Address - Fax:
Practice Address - Street 1:10920 196TH ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-1706
Practice Address - Country:US
Practice Address - Phone:718-877-9654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY426444163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant