Healthcare Provider Details

I. General information

NPI: 1619135787
Provider Name (Legal Business Name): STELLA ZAVELYUK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2792 OCEAN AVE FL 3
BROOKLYN NY
11229-4731
US

IV. Provider business mailing address

2792 OCEAN AVE FL 3
BROOKLYN NY
11229-4731
US

V. Phone/Fax

Practice location:
  • Phone: 718-942-4222
  • Fax: 347-533-6749
Mailing address:
  • Phone: 718-942-4222
  • Fax: 347-533-6749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number247178
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: