Provider Demographics
NPI:1205258183
Name:CANSELO, NIESHA (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:NIESHA
Middle Name:
Last Name:CANSELO
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 PARKVIEW AVE
Mailing Address - Street 2:4G
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-1331
Mailing Address - Country:US
Mailing Address - Phone:646-981-8780
Mailing Address - Fax:
Practice Address - Street 1:245 PARKVIEW AVE
Practice Address - Street 2:4G
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-1331
Practice Address - Country:US
Practice Address - Phone:646-981-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY494399163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant