Provider Demographics
NPI:1841522950
Name:EVANS, ASHA BAMMI (CPED)
Entity type:Individual
Prefix:MS
First Name:ASHA
Middle Name:BAMMI
Last Name:EVANS
Suffix:
Gender:F
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1758 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-6314
Mailing Address - Country:US
Mailing Address - Phone:518-952-4849
Mailing Address - Fax:518-952-4988
Practice Address - Street 1:1758 UNION ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-6314
Practice Address - Country:US
Practice Address - Phone:518-952-4849
Practice Address - Fax:518-952-4988
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor