Healthcare Provider Details

I. General information

NPI: 1851205736
Provider Name (Legal Business Name): MARIA YAMSHCHYKOVA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N 12TH ST STE 704
BROOKLYN NY
11249-1002
US

IV. Provider business mailing address

65 ORIENTAL BLVD APT 3M
BROOKLYN NY
11235-4917
US

V. Phone/Fax

Practice location:
  • Phone: 718-213-6628
  • Fax:
Mailing address:
  • Phone: 718-213-6628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number031190
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: