Provider Demographics
NPI:1821987579
Name:DEVERAUX, KATELYN MARGARET
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARGARET
Last Name:DEVERAUX
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 1:726 BELMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-1714
Mailing Address - Country:US
Mailing Address - Phone:631-394-8749
Mailing Address - Fax:
Practice Address - Street 1:726 BELMORE AVE
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-1714
Practice Address - Country:US
Practice Address - Phone:631-394-8749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program