Provider Demographics
NPI:1295164689
Name:WINES, VASHTI S (PSYD)
Entity type:Individual
Prefix:DR
First Name:VASHTI
Middle Name:S
Last Name:WINES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DANAMARIE LN
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-5609
Mailing Address - Country:US
Mailing Address - Phone:631-626-6217
Mailing Address - Fax:
Practice Address - Street 1:100 S MAIN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-3100
Practice Address - Country:US
Practice Address - Phone:631-626-6217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic