Provider Demographics
NPI:1417104555
Name:AVELINO, VERENYS (SLP)
Entity Type:Individual
Prefix:
First Name:VERENYS
Middle Name:
Last Name:AVELINO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 KENSINGTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:BUSHKILL
Mailing Address - State:PA
Mailing Address - Zip Code:18324-9474
Mailing Address - Country:US
Mailing Address - Phone:646-489-8991
Mailing Address - Fax:
Practice Address - Street 1:247 KENSINGTON DR
Practice Address - Street 2:
Practice Address - City:BUSHKILL
Practice Address - State:PA
Practice Address - Zip Code:18324-8137
Practice Address - Country:US
Practice Address - Phone:646-489-8991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013847-1235Z00000X
PASL008135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist