Provider Demographics
NPI:1720017387
Name:SEVILLA, EVELYN ALACANTARA (MD)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:ALACANTARA
Last Name:SEVILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9217 PARK WEST BLVD
Mailing Address - Street 2:SUITE A3
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4404
Mailing Address - Country:US
Mailing Address - Phone:865-531-2151
Mailing Address - Fax:865-691-3464
Practice Address - Street 1:9217 PARK WEST BLVD
Practice Address - Street 2:SUITE A3
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4404
Practice Address - Country:US
Practice Address - Phone:865-531-2151
Practice Address - Fax:865-691-3464
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000185162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0081829OtherBLUE CROSS BLUE SHIELD
0081829OtherBLUE CROSS BLUE SHIELD
3030381Medicare ID - Type Unspecified