Provider Demographics
NPI:1851039507
Name:VANDENBERGH, KARLA JOY (LAC)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:JOY
Last Name:VANDENBERGH
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 1:204 VOORHEES AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1643
Mailing Address - Country:US
Mailing Address - Phone:716-425-2692
Mailing Address - Fax:
Practice Address - Street 1:204 VOORHEES AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1643
Practice Address - Country:US
Practice Address - Phone:716-425-2692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005970171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist