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General NPI Number Information
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NPI Number | 1407455884
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Entity Type | Individual
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Provider Name | VEDALIE SOUVENANCE NP
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Gender | Female
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Dates
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Enumeration Date | 10/18/2020
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 21229 HILLSIDE AVE APT 3JE
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-1851
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Country | US
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Telephone | 917-825-0930
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Fax |
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Provider Business Mailing Address
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Address Line | 1266 DEKOVEN ST
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-3402
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Country | US
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Telephone | 917-825-0930
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F311426-01
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License Number State | NY
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