Provider Demographics
NPI:1134982598
Name:CEVAN, ISABELL B (IBCLC, RDH)
Entity type:Individual
Prefix:
First Name:ISABELL
Middle Name:B
Last Name:CEVAN
Suffix:
Gender:F
Credentials:IBCLC, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-1824
Mailing Address - Country:US
Mailing Address - Phone:917-855-3708
Mailing Address - Fax:
Practice Address - Street 1:5 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-1824
Practice Address - Country:US
Practice Address - Phone:917-855-3708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026839-01124Q00000X
NYL-314234174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty