Provider Demographics
NPI:1962944314
Name:VELAZQUEZ, DEURIA (CPT CCMA)
Entity type:Individual
Prefix:MRS
First Name:DEURIA
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:CPT CCMA
Other - Prefix:MRS
Other - First Name:DEURIA
Other - Middle Name:
Other - Last Name:FIELDS-KERCADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPT CCMA
Mailing Address - Street 1:89 KENSINGTON WAY
Mailing Address - Street 2:PO BOX 345
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2133
Mailing Address - Country:US
Mailing Address - Phone:845-423-9317
Mailing Address - Fax:877-512-7911
Practice Address - Street 1:89 KENSINGTON WAY
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2133
Practice Address - Country:US
Practice Address - Phone:845-423-9317
Practice Address - Fax:877-512-7911
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYM2C2R9G2246RP1900X
NYP9J3W8Z7376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No376K00000XNursing Service Related ProvidersNurse's Aide