Provider Demographics
NPI:1861936254
Name:YAVALDAKIS, JEANETTE (MS, SLP-CCC)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:
Last Name:YAVALDAKIS
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:MS
Other - First Name:JEANETTE
Other - Middle Name:
Other - Last Name:YAVALDAKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:49 NOYES ST
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2925
Mailing Address - Country:US
Mailing Address - Phone:845-536-9536
Mailing Address - Fax:
Practice Address - Street 1:91 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-1708
Practice Address - Country:US
Practice Address - Phone:845-536-9536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028264235Z00000X
NJ41YS00855600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist