Healthcare Provider Details

I. General information

NPI: 1003770777
Provider Name (Legal Business Name): EVELYN REYES PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 JASON PL STE 201
MIDDLETOWN NY
10940-1909
US

IV. Provider business mailing address

14 JASON PL STE 201
MIDDLETOWN NY
10940-1909
US

V. Phone/Fax

Practice location:
  • Phone: 845-800-5118
  • Fax:
Mailing address:
  • Phone: 862-571-8801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407698
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: