Provider Demographics
NPI:1164880332
Name:HERNAEZ, EVITA K (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:EVITA
Middle Name:K
Last Name:HERNAEZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 RUGBY RD
Mailing Address - Street 2:APT 4B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1548
Mailing Address - Country:US
Mailing Address - Phone:929-841-6475
Mailing Address - Fax:
Practice Address - Street 1:619 RUGBY RD
Practice Address - Street 2:APT 4B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1548
Practice Address - Country:US
Practice Address - Phone:929-841-6475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025380235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist