Healthcare Provider Details

I. General information

NPI: 1033032172
Provider Name (Legal Business Name): VENUS WORTHY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 FORTUNE RD W
MIDDLETOWN NY
10941-1625
US

IV. Provider business mailing address

15 FORTUNE RD W
MIDDLETOWN NY
10941-1625
US

V. Phone/Fax

Practice location:
  • Phone: 845-754-6743
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberNYCPS-P-80955
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: