Healthcare Provider Details

I. General information

NPI: 1285303214
Provider Name (Legal Business Name): AYENALIZ VELASQUEZ LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 STANWICH RD
GREENWICH CT
06830-3501
US

IV. Provider business mailing address

32 CESARIO PL FL 1
PORT CHESTER NY
10573-5102
US

V. Phone/Fax

Practice location:
  • Phone: 914-844-2503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number001943
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: