Provider Demographics
NPI:1356783161
Name:ISOLDI, VANESSA (PA)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:ISOLDI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 HOYT ST
Mailing Address - Street 2:TOP FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2912
Mailing Address - Country:US
Mailing Address - Phone:718-974-9280
Mailing Address - Fax:
Practice Address - Street 1:290 CENTRAL AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-8507
Practice Address - Country:US
Practice Address - Phone:516-239-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006320-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant