Healthcare Provider Details

I. General information

NPI: 1467522656
Provider Name (Legal Business Name): MICHELE A VACA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 S BROADWAY
YONKERS NY
10701-4004
US

IV. Provider business mailing address

127 S BROADWAY
YONKERS NY
10701-4006
US

V. Phone/Fax

Practice location:
  • Phone: 914-375-3200
  • Fax:
Mailing address:
  • Phone: 914-378-7586
  • Fax: 914-378-7991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number237612
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: