Provider Demographics
NPI:1538567813
Name:WINSTON, DEVERNIE
Entity type:Individual
Prefix:
First Name:DEVERNIE
Middle Name:
Last Name:WINSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1488 5TH AVE
Mailing Address - Street 2:APT. 2N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1488 5TH AVE
Practice Address - Street 2:APT 2N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2705
Practice Address - Country:US
Practice Address - Phone:315-566-9227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist