Provider Demographics
NPI:1245981778
Name:MACAVINTA, YVETTE
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:MACAVINTA
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 1:15 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 OAK WAY
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:ME
Practice Address - Zip Code:04002-7375
Practice Address - Country:US
Practice Address - Phone:207-730-0851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT5833208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation