Provider Demographics
NPI:1639605447
Name:AREVALO, AMARILIS Y (MSED)
Entity Type:Individual
Prefix:MRS
First Name:AMARILIS
Middle Name:Y
Last Name:AREVALO
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 1:7000 AUSTIN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FOREST HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-762-7633
Mailing Address - Fax:
Practice Address - Street 1:3605 SEDGWICK AVE
Practice Address - Street 2:APT B41
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-6039
Practice Address - Country:US
Practice Address - Phone:718-708-6402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2370589174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist