Healthcare Provider Details

I. General information

NPI: 1346109808
Provider Name (Legal Business Name): MS. LAURA ELIZABETH AVELLINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1689 ROUTE 22
BREWSTER NY
10509-4022
US

IV. Provider business mailing address

81 SOMERSET DR
PATTERSON NY
12563-2519
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-2995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: