Provider Demographics
NPI:1972051308
Name:OVIEDO OVIEDO, AURELINA
Entity Type:Individual
Prefix:
First Name:AURELINA
Middle Name:
Last Name:OVIEDO OVIEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 SOUTH LEXINGTON AVE, APT 6E
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606
Mailing Address - Country:US
Mailing Address - Phone:914-646-9371
Mailing Address - Fax:
Practice Address - Street 1:210 N CENTRAL AVE STE 340A
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1952
Practice Address - Country:US
Practice Address - Phone:914-428-5151
Practice Address - Fax:914-428-7660
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010522-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant