Individual
MRS. MINDY EVANGELISTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-2433
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(215) 707-2433
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
25MP00465500
NJ
363AM0700X
Medical Physician Assistant
2470
CO
363AM0700X
Medical Physician Assistant
Primary
MA059602
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
50307711
—
CO
01
—
51858754
MEDICAID GROUP NUMBER
CO
01
—
87588820
MEDICAID GROUP NUMBER
CO
01
—
C810212
MEDICARE GROUP NUMBER
CO
01
—
C810776
MEDICAID GROUP NUMBER
CO
Enumeration date
10/24/2007
Last updated
04/16/2021
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