Provider Demographics
NPI:1699241836
Name:RILEY, VANESSA SONIA
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:SONIA
Last Name:RILEY
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:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:AWENDAW
Mailing Address - State:SC
Mailing Address - Zip Code:29429-0416
Mailing Address - Country:US
Mailing Address - Phone:843-509-8213
Mailing Address - Fax:
Practice Address - Street 1:4138 OLD MEETING STREET RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-6662
Practice Address - Country:US
Practice Address - Phone:843-509-8213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide