Provider Demographics
NPI:1144465170
Name:NIEVES, EVELYN (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:
Last Name:NIEVES
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 DARROW PL
Mailing Address - Street 2:APT 23 A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-1802
Mailing Address - Country:US
Mailing Address - Phone:917-502-1327
Mailing Address - Fax:
Practice Address - Street 1:1028 E 179TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-2222
Practice Address - Country:US
Practice Address - Phone:718-842-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012112235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist