Provider Demographics
NPI:1336938521
Name:VERA, PAULA IGNACIA
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:IGNACIA
Last Name:VERA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 1/2 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-1812
Mailing Address - Country:US
Mailing Address - Phone:973-906-0896
Mailing Address - Fax:
Practice Address - Street 1:4 1/2 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-1812
Practice Address - Country:US
Practice Address - Phone:973-906-0896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86371063133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered