Individual provider Active NPI

Evelyn Villarde Candalera, NP-C

  • Nurse Practitioner
  • Montclair, NJ
National Provider Identifier
1861024796
Registry record updated Feb 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AG02200018 Issued in NJ
Practice address
48 N Fullerton Ave
Montclair, NJ 07042-3411
Phone
(973) 744-7337
Fax
(973) 744-5049
NPI assigned
Feb 8, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 26, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AG02200018 NJ Primary

Addresses

Primary practice location

48 N Fullerton Ave
Montclair, NJ 07042-3411

Mailing address

48 N Fullerton Ave
Montclair, NJ 07042-3411
Phone (973) 744-7337

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210512002014 NJ Practitioner - Nurse Practitioner 8123437647 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AG02200018NJMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Rowen Diano MD PA CurrentSince Jul 1, 2023 Accepting new patients
Pradip S. Shah, M.D. PastSince May 14, 2023 Accepting new patients
Seniormed Clinic for Aging PA PastSince Feb 1, 2020 Accepting new patients

Locations

48 N Fullerton Ave
Montclair, NJ 07042
Phone (973) 744-7337

33 N Fullerton Ave
Ste 1
Montclair, NJ 07042
Phone (973) 744-7337

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1581120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740528000000",
    "number": "1861024796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 N FULLERTON AVE",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070423411",
            "telephone_number": "973-744-7337",
            "fax_number": "973-744-5049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 N FULLERTON AVE",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070423411",
            "telephone_number": "973-744-7337",
            "fax_number": "973-744-5049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANDALERA",
        "first_name": "EVELYN",
        "middle_name": "VILLARDE",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-08",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NJ",
            "license": "AG02200018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montclair, NJ

Sources for this page

Verify at the official NPI Registry.