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General NPI Number Information
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NPI Number | 1073158689
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Entity Type | Individual
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Provider Name | VANDA RUDEZ
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Gender | Female
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Dates
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Enumeration Date | 11/07/2019
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Last Update Date | 11/07/2019
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Provider Practice Location Address
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Address Line | 3151 STONY ST
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City | MOHEGAN LAKE
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State | NY
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Zip | 10547-1913
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Country | US
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Telephone | 914-885-0110
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 402
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City | JEFFERSON VALLEY
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State | NY
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Zip | 10535-0402
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Country | US
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Telephone | 321-424-0654
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State | NY
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