Provider Demographics
NPI:1023311586
Name:EVANGELISTA, ROSARIA (MS, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:MS
First Name:ROSARIA
Middle Name:
Last Name:EVANGELISTA
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 TRUMAN AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-1113
Mailing Address - Country:US
Mailing Address - Phone:914-965-0040
Mailing Address - Fax:
Practice Address - Street 1:61 TRUMAN AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-1113
Practice Address - Country:US
Practice Address - Phone:914-965-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist