Provider Demographics
NPI:1497906275
Name:ESCUDERO, ADRIANE VELASQUEZ (MS, MA, BS)
Entity Type:Individual
Prefix:MRS
First Name:ADRIANE
Middle Name:VELASQUEZ
Last Name:ESCUDERO
Suffix:
Gender:F
Credentials:MS, MA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 DANBURY ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-5820
Mailing Address - Country:US
Mailing Address - Phone:631-206-0402
Mailing Address - Fax:
Practice Address - Street 1:80 DANBURY ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5820
Practice Address - Country:US
Practice Address - Phone:631-206-0402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15093-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics