Provider Demographics
NPI:1649490079
Name:ACEVEDO, DONNA E (PNP)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:E
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 TIEMANN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-6205
Mailing Address - Country:US
Mailing Address - Phone:718-547-7259
Mailing Address - Fax:
Practice Address - Street 1:3750 BAYCHESTER AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-5036
Practice Address - Country:US
Practice Address - Phone:718-654-5509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY380976390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program