Provider Demographics
NPI:1710123948
Name:BANHAM RIOLO, EVA MARIE (SLP)
Entity Type:Individual
Prefix:MS
First Name:EVA
Middle Name:MARIE
Last Name:BANHAM RIOLO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:EVA
Other - Middle Name:MARIE
Other - Last Name:BANHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 SEAMAN AVE.
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-884-9994
Mailing Address - Fax:
Practice Address - Street 1:25 SEAMAN AVE.
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-884-9994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003589 NEW YORK235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist