Provider Demographics
NPI:1851646723
Name:CEVALLOS, JUDY (MA)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:CEVALLOS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 51ST AVE
Mailing Address - Street 2:UNIT 321
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5730
Mailing Address - Country:US
Mailing Address - Phone:917-474-8424
Mailing Address - Fax:
Practice Address - Street 1:217 51ST AVE
Practice Address - Street 2:UNIT 321
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5730
Practice Address - Country:US
Practice Address - Phone:917-474-8424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator