Provider Demographics
NPI:1013455740
Name:MEVS, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:MEVS
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 1:45 RICHMOND BLVD
Mailing Address - Street 2:1A
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-3444
Mailing Address - Country:US
Mailing Address - Phone:917-825-1770
Mailing Address - Fax:
Practice Address - Street 1:45 RICHMOND BLVD
Practice Address - Street 2:1A
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-3444
Practice Address - Country:US
Practice Address - Phone:917-825-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist