Provider Demographics
NPI:1669083986
Name:VAZQUEZ, DAYNIA ALYSSE
Entity type:Individual
Prefix:
First Name:DAYNIA
Middle Name:ALYSSE
Last Name:VAZQUEZ
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 1:2048 31ST ST APT B8
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2545
Mailing Address - Country:US
Mailing Address - Phone:646-258-9962
Mailing Address - Fax:
Practice Address - Street 1:2048 31ST ST APT B8
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2545
Practice Address - Country:US
Practice Address - Phone:646-258-9962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool