Healthcare Provider Details

I. General information

NPI: 1306146642
Provider Name (Legal Business Name): RAQUEL VAMOS-LIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 NORTH COUNTRY ROAD
MILLER PLACE NY
11764
US

IV. Provider business mailing address

491 NORTH COUNTRY ROAD
MILLERPLACE NY
11764
US

V. Phone/Fax

Practice location:
  • Phone: 631-891-7008
  • Fax:
Mailing address:
  • Phone: 631-605-7297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007914
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number296167
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: