Healthcare Provider Details

I. General information

NPI: 1346179355
Provider Name (Legal Business Name): VANESSA HAIRSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7713 RIDGE BLVD FL 2
BROOKLYN NY
11209-3009
US

IV. Provider business mailing address

7713 RIDGE BLVD FL 2
BROOKLYN NY
11209-3009
US

V. Phone/Fax

Practice location:
  • Phone: 917-576-8650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number007046
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: