Healthcare Provider Details

I. General information

NPI: 1780590877
Provider Name (Legal Business Name): GECENIA ASHLEY VASQUEZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 LEDGEVIEW CT
BREWSTER NY
10509-2682
US

IV. Provider business mailing address

11 LEDGEVIEW CT
BREWSTER NY
10509-2682
US

V. Phone/Fax

Practice location:
  • Phone: 347-933-8470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN31302
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: