Provider Demographics
NPI:1255897211
Name:FARYEN, VANESSA S
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:S
Last Name:FARYEN
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 1:1151 CLEVELAND AVE STE AB
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3600
Mailing Address - Country:US
Mailing Address - Phone:404-669-9669
Mailing Address - Fax:404-669-9668
Practice Address - Street 1:1151 CLEVELAND AVE STE AB
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3600
Practice Address - Country:US
Practice Address - Phone:404-669-9669
Practice Address - Fax:404-669-9668
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA229654363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner