Provider Demographics
NPI:1558623157
Name:YALVAC, SUSAN (MSED)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:YALVAC
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 SWAN LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-4438
Mailing Address - Country:US
Mailing Address - Phone:516-521-4631
Mailing Address - Fax:
Practice Address - Street 1:186 SWAN LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-4438
Practice Address - Country:US
Practice Address - Phone:516-521-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist