Healthcare Provider Details

I. General information

NPI: 1326972795
Provider Name (Legal Business Name): MARIANA VASILITA AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 W BRIGHTON AVE STE 103
BROOKLYN NY
11224-4901
US

IV. Provider business mailing address

1150 BRIGHTON BEACH AVE APT 2F
BROOKLYN NY
11235-5945
US

V. Phone/Fax

Practice location:
  • Phone: 718-581-8109
  • Fax:
Mailing address:
  • Phone: 347-260-9968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: