Provider Demographics
NPI:1871054213
Name:EVSEVICH, MARIYA (RN)
Entity type:Individual
Prefix:
First Name:MARIYA
Middle Name:
Last Name:EVSEVICH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 DUMONT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1450
Mailing Address - Country:US
Mailing Address - Phone:718-667-8510
Mailing Address - Fax:718-667-4524
Practice Address - Street 1:26 DUMONT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1450
Practice Address - Country:US
Practice Address - Phone:718-667-8510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY766407163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse