Provider Demographics
NPI:1518608991
Name:LODATO, EVANA MARIA (PA)
Entity Type:Individual
Prefix:
First Name:EVANA
Middle Name:MARIA
Last Name:LODATO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HOFSTRA DR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2018
Mailing Address - Country:US
Mailing Address - Phone:631-495-5619
Mailing Address - Fax:
Practice Address - Street 1:7 HOFSTRA DR
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2018
Practice Address - Country:US
Practice Address - Phone:631-495-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant