MEDICARE: MS. DESHAWN LATRICE VINES RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	N09032-01	NY
2	282N00000X	General Acute Care Hospital	N09032-01	NY
3	207Q00000X	Family Medicine Physician	N09032-01	NY

General Provider Information

NPI Number	:	1144184532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DESHAWN LATRICE VINES RN

Provider Business Mailing Address
First Line	:	53 SCHOOL ST APT 4F
Second Line	:
City	:	BEDFORD HILLS
State	:	NY
Zip	:	10507-1918
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 SCHOOL ST APT 4F
Second Line	:
City	:	BEDFORD HILLS
State	:	NY
Zip	:	10507-1918
Country	:	US
Telephone Number	:	347-419-6860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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