Provider Demographics
NPI:1427696905
Name:GASPARD, VANESSA LISA
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:LISA
Last Name:GASPARD
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 1:355 NE 159TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33162-5007
Mailing Address - Country:US
Mailing Address - Phone:786-390-4511
Mailing Address - Fax:
Practice Address - Street 1:355 NE 159TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33162-5007
Practice Address - Country:US
Practice Address - Phone:786-390-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL12632731744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management