Provider Demographics
NPI:1649675786
Name:MCDOWELL, VANESSA ANN
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANN
Last Name:MCDOWELL
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 1:4728 11TH ST APT 5A
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-6151
Mailing Address - Country:US
Mailing Address - Phone:954-558-8298
Mailing Address - Fax:
Practice Address - Street 1:333 E 38TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2772
Practice Address - Country:US
Practice Address - Phone:646-501-7300
Practice Address - Fax:646-754-9512
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108328363A00000X
NY022112-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9108328OtherPA LICENCE NUMBER