Healthcare Provider Details

I. General information

NPI: 1871408195
Provider Name (Legal Business Name): VANESSA EDMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 S DIXIE HWY W APT 107
POMPANO BEACH FL
33060-8546
US

IV. Provider business mailing address

1217 S DIXIE HWY W APT 107
POMPANO BEACH FL
33060-8546
US

V. Phone/Fax

Practice location:
  • Phone: 954-224-7464
  • Fax:
Mailing address:
  • Phone: 954-224-7464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberE238-268-46-800-0
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: