Provider Demographics
NPI:1275954638
Name:AVILA, ANITA (AUD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:AVILA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 86TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11369-1026
Mailing Address - Country:US
Mailing Address - Phone:347-724-0107
Mailing Address - Fax:646-395-3309
Practice Address - Street 1:152 MADISON AVE
Practice Address - Street 2:1104
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5424
Practice Address - Country:US
Practice Address - Phone:212-921-1666
Practice Address - Fax:636-395-3309
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002502231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist