Provider Demographics
NPI:1063975860
Name:MOONSAMMY, VILKA M
Entity type:Individual
Prefix:
First Name:VILKA
Middle Name:M
Last Name:MOONSAMMY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3953 VALENCIA GROVE LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1727
Mailing Address - Country:US
Mailing Address - Phone:407-489-6731
Mailing Address - Fax:
Practice Address - Street 1:3953 VALENCIA GROVE LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-1727
Practice Address - Country:US
Practice Address - Phone:407-489-6731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY355882-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse