Healthcare Provider Details

I. General information

NPI: 1306765789
Provider Name (Legal Business Name): EBONI ET IVORIE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 GRAMATAN AVE APT 1F
MOUNT VERNON NY
10552-1826
US

IV. Provider business mailing address

630 GRAMATAN AVE APT 1F
MOUNT VERNON NY
10552-1826
US

V. Phone/Fax

Practice location:
  • Phone: 929-464-5659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: EBONI TRAVIS
Title or Position: OWNER
Credential: CD
Phone: 929-464-5659