Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 042-0009551 | VT |
N | 2080A0000X | Adolescent Medicine | 0420009551 | VT |
NPI | 1073641890 |
---|---|
Provider Name | Roya Mansoorani |
First Address | Williston, VT 05495-9308 |
Second Address | Saint Albans, VT 05478-9701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2007 |
Last Update Date | 29/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1006271 | (05) | VT |
38096 | BLUE CROSS BLUE SHIELD (01) | VT |