Provider Demographics
NPI:1407505480
Name:SEVERIN AVIN, JUDITH (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:SEVERIN AVIN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:SEVERIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:8268 164TH ST STE P113
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1104
Mailing Address - Country:US
Mailing Address - Phone:718-883-4500
Mailing Address - Fax:718-883-6106
Practice Address - Street 1:8268 164TH ST STE P113
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1104
Practice Address - Country:US
Practice Address - Phone:718-883-4500
Practice Address - Fax:718-883-6106
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF350463-01363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care