MEDICARE: MS. MARINA ZAVULUNOV TSSLD

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

General Provider Information

NPI Number	:	1477811487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARINA ZAVULUNOV TSSLD

Provider Business Mailing Address
First Line	:	5609 15TH AVE
Second Line	:	APT. 3G
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4749
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5609 15TH AVE
Second Line	:	APT. 3G
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4749
Country	:	US
Telephone Number	:	646-552-8926
Fax Number	:

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

Provider Enumeration Date	:	04/26/2012
Last Update Date	:	04/27/2012

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