Provider Demographics
NPI:1497029730
Name:TAHA, VANESSA QUEZADA (CRNA)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:QUEZADA
Last Name:TAHA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARIA VANESSA
Other - Middle Name:QUEZADA
Other - Last Name:BILKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:20 SHADY BROOK CT
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6137
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:118 N BEDFORD RD
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2553
Practice Address - Country:US
Practice Address - Phone:800-362-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ89166367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered