Provider Demographics
NPI:1578825212
Name:MAZZELLA, EVELYN (MS ED)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:MAZZELLA
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S. HIGHLAND AVE
Mailing Address - Street 2:5L
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562
Mailing Address - Country:US
Mailing Address - Phone:914-473-7928
Mailing Address - Fax:
Practice Address - Street 1:121 S HIGHLAND AVE
Practice Address - Street 2:5L
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-5862
Practice Address - Country:US
Practice Address - Phone:914-473-7928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist