Provider Demographics
NPI:1205125234
Name:DZANDZA, VERONICA ATSUPUI
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:ATSUPUI
Last Name:DZANDZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 SOUNDVIEW AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-3046
Mailing Address - Country:US
Mailing Address - Phone:347-270-1470
Mailing Address - Fax:
Practice Address - Street 1:350 SOUNDVIEW AVE APT 1B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-3046
Practice Address - Country:US
Practice Address - Phone:347-270-1470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY635050-1163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health