Individual
VESTA YAZDANSETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
29 BRANCH LN, EAST SETAUKET, NY 11733-3316
(631) 681-9228
(631) 681-9228
Mailing address
14 WASHINGTON AVE, PORT JEFFERSON STATION, NY 11776-3074
(631) 473-0983
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
622666-1
NY
363LG0600X
Gerontology Nurse Practitioner
Primary
F307382-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
F307382-1
—
NY
Enumeration date
05/07/2010
Last updated
07/21/2022
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