Individual provider Active NPI

Evelyn Rose Vento, M.D.

  • Psychiatry Physician
  • Alexandria Bay, NY
National Provider Identifier
1023087418
Registry record updated Mar 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
341477 Issued in NY
Practice address
4 Fuller St
Alexandria Bay, NY 13607-1391
Phone
(315) 482-2511
NPI assigned
Mar 16, 2006
Last updated
Mar 18, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 341477 NY
Family Medicine Physician 207Q00000X 13735 HI
Psychiatry Physician 2084P0800X 13735 HI
Psychiatry Physician 2084P0800X 341477 NY Primary
Child & Adolescent Psychiatry Physician 2084P0804X 341477 NY
Child & Adolescent Psychiatry Physician 2084P0804X 13735 HI

Addresses

Primary practice location

4 Fuller St
Alexandria Bay, NY 13607-1391

Mailing address

16237 Deer Run Rd
Watertown, NY 13601-5367

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260326001982 NY Practitioner - PsychiatryPractitioner - Family Practice 3870775125 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
PsychiatryAlso: Family Practice
Education
Other, 2004
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1997 State Hwy 72
Potsdam, NY 13676-3340

4 Fuller St
Alexandria Bay, NY 13607-1391

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773792000000",
    "number": "1023087418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16237 DEER RUN RD",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136015367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 FULLER ST",
            "city": "ALEXANDRIA BAY",
            "state": "NY",
            "postal_code": "136071391",
            "telephone_number": "315-482-2511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENTO",
        "first_name": "EVELYN",
        "middle_name": "ROSE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-16",
        "last_updated": "2026-03-18",
        "certification_date": "2026-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "341477",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "HI",
            "license": "13735",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "HI",
            "license": "13735",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "341477",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NY",
            "license": "341477",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "HI",
            "license": "13735",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria Bay, NY

Sources for this page

Verify at the official NPI Registry.