Provider Demographics
NPI:1053960153
Name:SANCHEZ, VANESSA (LPN)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4004
Mailing Address - Country:US
Mailing Address - Phone:631-704-2155
Mailing Address - Fax:
Practice Address - Street 1:32 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4004
Practice Address - Country:US
Practice Address - Phone:631-704-2155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330336-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty