Provider Demographics
NPI:1902339534
Name:DEL ROSARIO, EVERLYN (MASTERS)
Entity Type:Individual
Prefix:
First Name:EVERLYN
Middle Name:
Last Name:DEL ROSARIO
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 GREYSTONE AVE APT 6C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1913
Mailing Address - Country:US
Mailing Address - Phone:646-468-5513
Mailing Address - Fax:
Practice Address - Street 1:3840 GREYSTONE AVE APT 6C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1913
Practice Address - Country:US
Practice Address - Phone:646-468-5513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY925473151390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program