MEDICARE: NATALLIA VETASHNIKAVA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	559907111	NY

General Provider Information

NPI Number	:	1154603835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALLIA VETASHNIKAVA

Provider Business Mailing Address
First Line	:	1701 QUENTIN RD
Second Line	:	APT. C 1
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1269
Country	:	US
Telephone Number	:	347-232-5597
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 QUENTIN RD
Second Line	:	APT. C 1
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1269
Country	:	US
Telephone Number	:	347-232-5597
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2011
Last Update Date	:	09/19/2011

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Directions to “ NATALLIA VETASHNIKAVA ” Practice Location

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