Provider Demographics
NPI:1699231324
Name:RODDY, VERONICA CARLEVALE
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:CARLEVALE
Last Name:RODDY
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 1:23 HACKETT BLVD # MC208
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3436
Mailing Address - Country:US
Mailing Address - Phone:518-262-3341
Mailing Address - Fax:
Practice Address - Street 1:23 HACKETT BLVD # MC208
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3436
Practice Address - Country:US
Practice Address - Phone:518-262-3341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302849363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health