Healthcare Provider Details

I. General information

NPI: 1447881313
Provider Name (Legal Business Name): VANESSA SOPHIA GOLDING RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 LAWRENCE AVE
BROOKLYN NY
11230-1103
US

IV. Provider business mailing address

2020 E 41ST ST APT 6G
BROOKLYN NY
11234-2937
US

V. Phone/Fax

Practice location:
  • Phone: 212-204-5178
  • Fax:
Mailing address:
  • Phone: 718-909-8132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number502262
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: