Provider Demographics
NPI:1922424720
Name:VICIOSO, MARIA SOBEIDA (MS SP ED)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:SOBEIDA
Last Name:VICIOSO
Suffix:
Gender:F
Credentials:MS SP ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10231 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2906
Mailing Address - Country:US
Mailing Address - Phone:917-445-2341
Mailing Address - Fax:
Practice Address - Street 1:10231 92ND AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2906
Practice Address - Country:US
Practice Address - Phone:917-445-2341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1181222174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist