Individual
AWILDA VASQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
62 WHITEPOND ROAD, STORMVILLE, NY 12582
(917) 699-4286
Mailing address
62 WHITEPOND ROAD, STORMVILLE, NY 12582
(917) 699-4286
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
779452
NY
Other
Enumeration date
11/29/2016
Last updated
11/29/2016
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