Provider Demographics
NPI:1689812455
Name:SCHEVELOFF, AUDREY MONET (MASTERS)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:MONET
Last Name:SCHEVELOFF
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:MONET
Other - Last Name:SCHEVELOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MASTERS
Mailing Address - Street 1:243 MULBERRY ST
Mailing Address - Street 2:APARTMENT # 2L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-4165
Mailing Address - Country:US
Mailing Address - Phone:917-209-1600
Mailing Address - Fax:
Practice Address - Street 1:243 MULBERRY ST
Practice Address - Street 2:APARTMENT # 2L
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-4165
Practice Address - Country:US
Practice Address - Phone:917-209-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-01
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014170225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist