Provider Demographics
NPI:1801648035
Name:ISLAM, EVANA
Entity type:Individual
Prefix:
First Name:EVANA
Middle Name:
Last Name:ISLAM
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 1:1415 HIGHWAY 6 STE D100
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-5137
Mailing Address - Country:US
Mailing Address - Phone:346-391-5743
Mailing Address - Fax:832-218-7599
Practice Address - Street 1:1415 HIGHWAY 6 STE D100
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-5137
Practice Address - Country:US
Practice Address - Phone:346-391-5743
Practice Address - Fax:832-218-7599
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician