Provider Demographics
NPI:1922009513
Name:DINNALL, VANESSA NICOLA (MD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:NICOLA
Last Name:DINNALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 N BROADWAY
Mailing Address - Street 2:SUITE 560, SLEEPY HOLLOW MEDICAL GROUP
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1075
Mailing Address - Country:US
Mailing Address - Phone:914-631-0337
Mailing Address - Fax:914-631-0552
Practice Address - Street 1:755 N BROADWAY
Practice Address - Street 2:SUITE 560, SLEEPY HOLLOW MEDICAL GROUP
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1075
Practice Address - Country:US
Practice Address - Phone:914-631-0337
Practice Address - Fax:914-631-0552
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228585-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01570034Medicaid
NYI02244Medicare UPIN
NY01570034Medicaid