Doctor Name: | VANESSA LALLEY-DEMONG |
NPI Number: | 1841511342 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DO |
License Number: | |
Business Practice Address: | 4104 Medical Center Dr Suite 104 Fayetteville, NY - 130666635 |
Business Phone Number: | 3156630059 |
Business Fax Number: | 3156630123 |
Mailing Address: | 5100 W Taft Rd, Suite 1d Credentialing LIVERPOOL |
State: | NY |
Postal Code: | 130883807 |
Phone Number: | 3157441865 |
Fax Number: | 3157441954 |
NPI Enumeration Date: | 06/18/2010 |
NPI Last Update Date: | 03/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |