Healthcare Provider Details

I. General information

NPI: 1437013760
Provider Name (Legal Business Name): YVANGELISE MONE VELASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 BELDEN AVE STE 4
NORWALK CT
06850-3314
US

IV. Provider business mailing address

1326 E MAIN ST
BRIDGEPORT CT
06608-1417
US

V. Phone/Fax

Practice location:
  • Phone: 203-772-8161
  • Fax: 203-580-8319
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: