Provider Demographics
NPI:1356786586
Name:VILLAFANA, PETRONILA
Entity type:Individual
Prefix:
First Name:PETRONILA
Middle Name:
Last Name:VILLAFANA
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 1:8722 88TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2031
Mailing Address - Country:US
Mailing Address - Phone:718-849-2194
Mailing Address - Fax:
Practice Address - Street 1:88-66 MYRTLE AVE
Practice Address - Street 2:LITTLE WONDERS, INC.
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385
Practice Address - Country:US
Practice Address - Phone:718-850-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator