Healthcare Provider Details

I. General information

NPI: 1407341084
Provider Name (Legal Business Name): VANESSA PACELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 SILLS RD
YAPHANK NY
11980
US

IV. Provider business mailing address

19 ROY AVE
MASSAPEQUA NY
11758-6755
US

V. Phone/Fax

Practice location:
  • Phone: 631-924-5583
  • Fax:
Mailing address:
  • Phone: 203-305-0377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number010968
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: