Provider Demographics
NPI:1003341850
Name:SMALL-CLARKE, VILETHA
Entity type:Individual
Prefix:
First Name:VILETHA
Middle Name:
Last Name:SMALL-CLARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VILETHA
Other - Middle Name:C
Other - Last Name:SMALL-CLARKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:441 EAST 53RD STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:347-982-3034
Mailing Address - Fax:
Practice Address - Street 1:441 E 53RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-4505
Practice Address - Country:US
Practice Address - Phone:347-982-3034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily