Provider Demographics
NPI:1134439227
Name:VEALEY, JUDY KAY (CFM)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:KAY
Last Name:VEALEY
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 EAST HURON RIVER DRIVE
Mailing Address - Street 2:1 NORTH
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197
Mailing Address - Country:US
Mailing Address - Phone:734-712-6163
Mailing Address - Fax:734-712-6160
Practice Address - Street 1:5301 EAST HURON RIVER DRIVE
Practice Address - Street 2:1 NORTH
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-712-6163
Practice Address - Fax:734-712-6160
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICFM01607224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter