Anastasia Evanoff, M.S.ED, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

028906 Issued in NY

Practice address

29-01 216TH Street
Center for Pediatric Feeding Disorders
Bayside, NY 11360

Phone

(718) 281-8947

NPI assigned

May 22, 2020

Last updated

May 22, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1590105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590105600000",
    "number": "1275156416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29-01 216TH STREET",
            "address_2": "CENTER FOR PEDIATRIC FEEDING DISORDERS",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "11360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29-01 216TH STREET",
            "address_2": "CENTER FOR PEDIATRIC FEEDING DISORDERS",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "11360",
            "telephone_number": "718-281-8947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANOFF",
        "first_name": "ANASTASIA",
        "credential": "M.S.ED, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-22",
        "last_updated": "2020-05-22",
        "certification_date": "2020-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "PA",
            "license": "SL014506",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "028906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Bayside, NY
• Providers in Bayside, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.