Provider Demographics
NPI:1780978973
Name:SODERSTROM, VANESSA ELIZABETH (MSED)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:ELIZABETH
Last Name:SODERSTROM
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 83RD ST
Mailing Address - Street 2:APT 2R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4522
Mailing Address - Country:US
Mailing Address - Phone:718-986-5535
Mailing Address - Fax:
Practice Address - Street 1:514 83RD ST
Practice Address - Street 2:APT 2R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4522
Practice Address - Country:US
Practice Address - Phone:718-986-5535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-05
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist