Provider Demographics
NPI:1730444944
Name:MERCED, VANESSA LEE
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:LEE
Last Name:MERCED
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 1:511 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:W HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2737
Mailing Address - Country:US
Mailing Address - Phone:718-413-6121
Mailing Address - Fax:516-565-2782
Practice Address - Street 1:24320 145TH AVE
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2326
Practice Address - Country:US
Practice Address - Phone:646-829-8066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator