Provider Demographics
NPI:1679611206
Name:PRAVDER, ROBERTA C (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:C
Last Name:PRAVDER
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 1:50 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1936
Mailing Address - Country:US
Mailing Address - Phone:516-487-9605
Mailing Address - Fax:516-829-6417
Practice Address - Street 1:50 CEDAR DR
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1936
Practice Address - Country:US
Practice Address - Phone:516-487-9605
Practice Address - Fax:516-829-6417
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist