Healthcare Provider Details

I. General information

NPI: 1093028367
Provider Name (Legal Business Name): EVELYN S DELEGAS CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ESSEX CENTER DR LAHEY NORTHSHORE
PEABODY MA
01960-2901
US

IV. Provider business mailing address

41 MALL RD LAHEY CLINIC
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 978-538-4361
  • Fax: 978-538-4748
Mailing address:
  • Phone: 978-538-4361
  • Fax: 978-538-4748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number452
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: