Provider Demographics
NPI:1790194173
Name:MOREAU, EVELYN (HIS)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:MOREAU
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9732 63RD RD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1639
Mailing Address - Country:US
Mailing Address - Phone:718-205-0664
Mailing Address - Fax:
Practice Address - Street 1:9732 63RD RD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1639
Practice Address - Country:US
Practice Address - Phone:718-205-0664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000039626237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist