Provider Demographics
NPI:1326850793
Name:TAVAREZ, AIMEE PATRICIA
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:PATRICIA
Last Name:TAVAREZ
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 1:551 W 157TH ST APT 62
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-7653
Mailing Address - Country:US
Mailing Address - Phone:347-283-1227
Mailing Address - Fax:
Practice Address - Street 1:551 W 157TH ST APT 62
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-7653
Practice Address - Country:US
Practice Address - Phone:347-283-1227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1697297231174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist